I have a painful swelling at my wrist
If you have noticed a small lump at the back or palmar side of your wrist, you might be suffering from a wrist ganglion.
What is a ganglion?
A ganglion is a bag filled with joint fluid. The wrist is comprised of 15 bones and there are plenty of little joints that can develop a ganglion. It is caused by overproduction of joint fluid due to inflammation or overuse. The excess fluid generates pressure which then escapes trough a small gap in the joint enclosure (capsule). It’s basically a little balloon filled with the gelatinous joint fluid and attached to to the capsule with it’s opening. The gap in the joint capsule acts a bit like a valve as fluid can enter the ganglion but cannot escape. This leads to different sizes of a ganglion and can also produce a dense and tender swelling.
Who gets a ganglion?
Ganglions are common and most of the times non-symptomatic. They occur in joints suffering from inflammation after overuse or in degenerative conditions such as arthritis.
How can a wrist ganglion be diagnosed?
The location and spongy consistency of ganglion give a first clue. Ultrasound is bale to image a wrist ganglion very well and X-rays can show underlying pathology such as arthritis.
Treatment for wrist ganglion
Non-symptomatic ganglions do not require specific management. In some cases however wrist ganglions grow rather large and cause irritation to the tendons that are crossing it. That produces a radiating pain into the forearm and also supports inflammation of the tendons (tenosynovitis). In these cases ultrasound guided needle aspiration and possibly cortisone injection can be considered. Unfortunately this treatment has a rather high recurrence rate as the gap in the joint capsule and the bag remain and often the ganglions fills back up within just a few days. In theses cases where non-non-operative management has failed, surgery is an option.
Surgery for wrist ganglion
The surgery for wrist ganglions can be carried out as a day case but requires general anaesthetic. Via a small direct incision inline with the skin lines the ganglion is carefully isolated from the surrounding tissue and excised in it’s entirety including the pedicle at the joint capsule. After wound closure usually does with internal stitches, local anaesthetic is injected and dressings including an elastic bandage placed.
Preparing for surgery for wrist ganglion
If required we will arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.
Recovery from surgery for wrist ganglion
After surgery for wrist ganglion it is encouraged to use the hand for light activities straight away. The wound heals within ten days and a hand therapist will care for dressing changes and more importantly exercises. These exercises aim to prevent adhesions with the tendons that are crossing the surgical field.