Ganglion
NHS Tayside RefGuide
Warning
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.
Information to include
- Refer with finger XR results to allow vetting to most appropriate specialty.
- Please include photograph of cyst on referral.
Symptoms and signs
- 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.
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).