During ganglion removal (Ganglion exstirpatio), ganglion cysts filled with fluid formed on the back of the hand or feet are removed as part of a one-day surgical procedure under local anaesthesia of the affected body part.
What is a ganglion?
The ganglion is a benign, gelatinous cyst on the hands and feet around the knees and ankles. It most commonly occurs on the back of the wrist, but it can also occur on the palm at the base of the fingers or the knuckles. It appears in the form of a small nodule which can vary from the size of a pea to the size of a walnut.
How does the ganglion form?
The ganglion cyst develops on the line of the joint or along the tendon sheath, essentially from the sacciformis protrusion of the joint sheath or tendon sheath. In this protrusion, the synovial fluid builds up and thickens, which first forms a saccule connected to a small tube by pressure on the joint sheath and surrounding tissues, and then detaches over time to form a separate ganglion cyst full of jelly-like fluid.
There is no specific reason for its development, but it can usually be related to some previous limb trauma or greater exertion. It can also develop as a result of joint wear, tenosynovitis, and forced sports activities.
It is most common in women aged 20-40. The size of the ganglion can change, grow, shrink and even disappear depending on the strain, but it can also recur over time.
What are the symptoms of a ganglion?
A visible symptom of a ganglion is a soft-touched, nodular lump filled with fluid on the affected part of the body, on the back or palm of the wrist, on the ankle or knee.
In the extended position of the limb, the cyst is palpable above the joint, which retracts into the joint when bent. In addition to moving the limb in this direction, there is also a click and pinching.
In many cases, the ganglion does not cause any complaints, but in some cases it can be associated with pain, especially when the affected part of the body is in active use, constantly strained.
The deformity caused by the ganglion can also have mental effects, the visible, not too aesthetic nodule can also cause anxiety and frustration in the patient.
How to treat the ganglion?
The diagnosis is made by the orthopaedic specialist based on the location, palpation and shape of the cyst. Imaging diagnostic devices (X-ray, CT, or MRI) may be recommended to rule out other joint lesions.
Treatment primarily depends on the complaints caused by the cyst. As a first step, it can be done in a conservative way, by resting, using non-steroidal anti-inflammatory drugs and fixatives. If this does not help, surgery may be needed.
When is the intervention necessary?
Surgical intervention may be necessary if, in addition to the visible deformity, it also causes complaints due to the location of the cyst: by applying pressure to the surrounding nerves, it causes pain, numbness and muscle weakness. Furthermore, surgery is necessary if conservative treatment has failed to eliminate the complaints.
Suction of the fluid accumulated in the ganglion is not the most effective procedure, because in such a case, only the fluid is removed from the cyst, the sheath remains, which can be refilled with fluid later under strain. In contrast, during surgical ganglion removal, the entire cyst, along with the sheath, is removed.
How is the surgery performed?
During the preoperative consultation, your orthopaedic specialist will provide detailed information about the necessary tests before the operation, as well as the course of the operation and its risks. Ganglion removal is performed as part of a one-day surgical procedure.
After surgical preparation, the affected limb is anesthetized locally. The specialist will look for the origin of the cyst and then excise the entire formula. Excision often involves the removal of the joint capsule or a small part of the tendon sheath.
After removal, the resulting wound is sutured with a few stitches by the specialist. Ganglion cysts removed during the procedure are also subjected to histological examination.
What are the dangers of the surgery?
As with any medical interventions, ganglion removal can have risks and complications. Rarely, however, inflammation and infection of the surgical area, as well as damage to the surrounding anatomical formulas, may occur. Medication is sufficient to treat milder cases, but in more severe cases, another surgery may be needed. The most serious complication can also be purulent inflammation of the operated area, which can be counteracted with strict adherence to hygienic rules.
What can I expect after the surgery?
After a few hours of observation after ganglion surgery, you can return home from our hospital that day. The bandage must be replaced the day after surgery, suture collection takes place after 10 days. It is very important that the wound and bandage are not exposed to water during this time. The operated area may be swollen and sensitive in the days after the procedure. The affected limb should be rested, helping the healing process. Total activity returns depending on the individual, after an average of 2 weeks, however, the limb should be gradually strained. Consultation with a physiotherapist is also recommended to help with rehabilitation.
The ganglion cyst may reappear after surgical removal if the limb is strained again similarly to the underlying cause.
Surgical ganglion removal is the most effective way to treat ganglion cysts, as there is minimal chance of recurrence in the affected area. Feel free to contact our team of orthopaedic specialists, who will be happy to answer your questions about the surgery.
We accommodate our clients in a modern, pleasant, air-conditioned single room. Each room has a private bathroom, fridge and TV, as well as free WIFI access. We also provide our clients with individual nurse supervision, who will help your continuous recovery during your stay.