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Ganglions of the Wrist

Ganglions of the wrist are extremely common and are utterly benign. Many do not cause pain but cause inconvenience because of their position.

Ganglions of the wrist come in two types; those that appear on the back of the wrist (dorsal ganglion) and those that appear on the palmar aspect (volar ganglion). I find the best way to consider a ganglion, is to think of a balloon. If you inflate a balloon then you will blow air through a narrow neck and produce a large bulbous shape at the other end. If you imagine that the bulbous end of the balloon is the lump you can feel in your wrist then the other end is all the way down into the wrist joint itself.

The ganglion is full of a thickish treacly fluid which gives it a slight bouncy feel when pressed. Sometimes a ganglion can feel rock hard when the fluid is under a lot of pressure. On the back of the wrist the ganglion extends down to and arises from the ligament between two of the bones of the wrist, the scaphoid and lunate. Occasionally it can arise from other areas on the back of the wrist but these are pretty rare.

They can be associated with a history of injury but in the majority of cases they spontaneously appear. Equally in the majority of cases they will spontaneously disappear but some will fluctuate up and down and some stay static. There is absolutely no evidence that they cause any long term complications, especially no increased risk of arthritis.

Indications for surgery are entirely based on the level and intensity of symptoms and the extent to which the ganglion causes a true functional disability. The surgical procedure itself is not without risk. There are all the usual ones (please see section Complications) but the main problem with wrist ganglion removal, is the high risk of recurrence. There have been many studies in the orthopaedic literature looking at this issue and the estimated risk of recurrence lies between 20 to 40%. However, if the dorsal ganglion is fully excised from the surface of the scapholunate ligament then the risk of recurrence is reduced to below 5%. Volar ganglions can be associted with degenerative changes in the wrist and this increases the risk of recurrence. Sometimes, it is better to address the arthritis changes, rather than simply excise the ganglion.

Further reading:

  • Article in the British Journal of Hand Surgery by J Dias
  • American Society for Surgery of the Hand

  • There have been many attempts to treat ganglia by aspiration and/or inserting a noxious substance. The results are unpredictable so I have abandoned this technique. If surgery for wrist ganglia is indicated, then it can be readily performed as a daycase under regional or general anaesthesia but not under local anaesthetic.

    Post-operative regime

  • The wrist will be wrapped in a well-padded bandage which can be reduced to tubigrip after a week. At this stage wrist movements can be started.
  • Activity can be started as long as it does not cause pain.
  • You can drive in the second week as long as you genuinely feel safe.