- Common, harmless and can safely be left alone
- Often there are no symptoms other than noticeable cystic swelling. If it is not painful, no treatment is required.
- Occasionally can cause pain and limited joint movement.
- About 50 % disappear without any treatment within 2-5 years
- Satisfaction with surgery is low
- Strong recommendation is to leave alone
- In event of surgery - Post op: Off work for up to 6 weeks depending on operation performed and occupation.
Ganglion
Symptoms and signs
Useful resources
Initial management
- Analgesia as appropriate if painful- simple wrist wrap around splints may help if appropriate (Allardyce/ Boots/online)
- Aspiration (up to 50% recurrence) may help painful symptoms. Do not repeat aspiration if ganglion recurs
Primary Care diagnostics
- Mucoid cyst: X-ray fingers to assess for any OA DIP joint
- ?Ultrasound scan for dorsal ganglion/ wrist swelling if in doubt about pathology (rule out giant cell tumour).
Who to refer
Further information to consider and discuss with patient prior to consideration of secondary care referral:
- Dorsal Ganglion cyst. Typically occurs in young adults and often disappears without treatment within 2-5 years. Draining it can reduce the swelling but it often returns. Surgery not advised as self-limiting condition., many surgeons no longer operate.
- Volar Ganglion cyst. May occur in young adults, but also seen in association with arthritis in older individuals. Aspiration may be useful, but care needed as the cyst is often close to radial artery. Many surgeons advise against operation for this self-limiting condition, satisfaction rates poor. Often disappears without treatment within 2-5 years.
- Ganglion cyst at the base of volar surface finger (Flexor tendon sheath). Typically occurs in young adults, causing pain when gripping and feeling like a dried pea sitting on the tendon sheath at the base of the finger. Persistent cysts can be removed surgically - risk of recurrence is small. Post op: Off work for up to 4 -6 weeks depending on occupation
- Mucous cyst. Usually in middle-aged or older people, associated with wearing out of DIP joint. Pressure from the cyst may cause a furrow in the fingernail. Occasionally the cyst fluid leaks through the thin overlying skin from time to time. Most disappear within 2 years, therefore surgery will not be considered unless present for 2 years. Risk of recurrence post op around 10%, problems after surgery include infection, stiffness and pain from the worn out joint. NB: Joint fusion may be advocated if XR shows OA changes, or small skin flap repair may be required.
Who not to refer
- Cosmesis
How to refer
- SCI Gateway/Hand Surgery. Patients may be seen initially by Advanced Practice Physiotherapist
- Refer with finger XR results to allow vetting to most appropriate specialty.
- Please include photograph of cyst on referral