ganglion presentation

8/4/2019 Ganglion Presentation

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Ganglions are the most common growth foundin the wrist and hand.

Ganglions are always benign

They are found at any age


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Ganglion Cyst Ganglions usually originate off ligaments from

inside joints

They can also originate off tendon sheaths

They may be associated with bone spurs

Ganglions are always benign they neverbecome worrisome


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Ganglion CystGanglions are thin-walled

sacs containing a thick,jelly-like fluid

Some ganglion causepain, while others causeno pain.


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Ganglion cyst Once a ganglion occurs, there are many

possibilities:

1. Ganglions may remain unchanged for manyyears

2. They often change in size and shape, or comeand go

3. Ganglions may go away on their own, withoutany treatment, and never come back


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Ganglions There are 4 types of ganglions that are

discussed in this side show.

If you want to learn about your specific type ofganglion only, and skip the others, then click onyour ganglion listed below:

Dorsal wrist ganglion

Volar wrist ganglion Flexor tendon sheath ganglion

Mucous Cyst


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Dorsal Wrist Ganglion


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Dorsal WristGanglionThe back or dorsal side of

the wrist is the mostcommon location for aganglion to be found.

These ganglions mostoften originate fromwithin the wrist joint, offa ligament called the

scapholunate ligament.


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Dorsal Wrist

GanglionThe Natural history of aganglion is variable andunpredictable.

Ganglions may stay the samefor many years, but they most

often change in size and shape

Ganglions can come and go,and occasionally will go awaypermanently on their ownwithout any treatment


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1. OBSERVATION: Ganglions are always benign, and

sometimes cause no pain or discomfort. It is safe tosimply live with the ganglion. Other treatment optionsare always available. Ganglions occasionally go awaypermanently without any treatment.


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2. ASPIRATION. The ganglion can be punctured with aneedle, and some of the fluid may be able to bedrained. The cyst remains in place, though, andpersistence or recurrence of the ganglion most oftenoccurs, reported from 60 to 90%.

No advantage has been found to add cortisone or tosplint the wrist afterwards.

The risk of recurrence is also high with the oldrecommendation of hitting the cyst with a book or Bible.


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3. SURGERY. Removal of the dorsal ganglion is anoutpatient surgery done in a hospital operating room.The surgery is usually performed under regional, orblock anesthesia.


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Some Surgeons perform ganglion cyst removal witharthroscopy.Reported success rates and recurrence rates are similar.The cost of the surgery is greater.Cedar Valley Hand Surgery does not use this technique.


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Dorsal Ganglion SurgerySurgery is done in ahospital operating room Ganglions are like balloons withthick jelly like fluid inside


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Ganglion CystSurgeryThe cyst is followed

down to theligament where itcomes from, and iscompletely excised.


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Dorsal Ganglion SurgeryThe entire ganglion isremoved Several sutures are placedand remain two weeks


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Dorsal GanglionSurgeryA wrist splint is

worn full-time fortwo weeks aftersurgery, thengradually less forthe next 2 to 4weeks


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Risks of Ganglion Surgery

Recurrence, meaning the later growth of a newganglion in the same location, is the mostcommon risk. The recurrence rate has been

reported from 10 to 40% in differentpublications.

Other risks include infection, loss of wristmotion, nerve injury, ligament injury, tendoninjury, scar tenderness and keloid formation.


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Volar Wrist Ganglion


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Volar Wrist Ganglion This is the second most common location for a

ganglion to occur.

This ganglion most often comes off a ligamentin the wrist joint called the scapho-trapezialligament

A volar ganglion is usually very close or

adherent to the radial artery


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Volar Ganglion


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Volar Ganglion Treatment

Options: Options are the same as for dorsal ganglions

observation, aspiration, or surgical excision.

If surgery is selected, the procedure andpostoperative plan are basically the same as fordorsal wrist ganglions

Risks of surgery are also the same, including

the risk of ganglion recurrence.


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Volar Ganglion -surgerySurgery is an outpatientsurgery done in a hospitaloperating room.

Usually done under

regional (block) anesthesia

Care is taken to protect theradial artery, which is oftenadherent to or within thecyst

A splint is worn aftersurgery for several weeks


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Volar Ganglion Surgery Sutures are removed

after two weeks.

Wrist motionexercises are neededto regain wristmotion.

A splint is graduallyworn less over 3 to 6weeks.


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Volar Ganglion Surgery

Possible Complications Infection, nerve injury, tendon injury

Injury to the radial artery

Painful scar or keloid formation

Loss of wrist motion

Later recurrence of ganglionreported

rates of 10 to 40%


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Flexor Tendon Sheath

Ganglion These ganglions

originate off a tendonsheath, which is a

fibrous tunnelsurrounding tendons.The sheath starts atthe distal palm and

extends down thefinger.


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Ganglion These ganglions are often more tender and

painful than other ganglions because they arecompressed with grip or grasp activities.

They often cause pain with gripping a steeringwheel, luggage handle, or other similar activity.


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Ganglion treatment options. These ganglions are benign, and may go away

on their own without coming back.

If not too painful or limiting, they can simply beobserved.

Aspiration of these ganglions is an option, andis more successful compared to aspirating other

ganglions Permanent resolution after aspiration of a flexor

tendon ganglion is 40-50%


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Aspiration The flexor tendon

ganglion can beaspirated under

sterile technique witha needle.

The ganglion iscollapsed, but not

removed


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Aspiration The area of the

ganglion should bemassaged

intermittently forseveral days afteraspiration


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Ganglion treatment options. Surgical excision of flexor tendon ganglions is

also an option.

This surgery is usually done under localanesthesia.

A padded dressing is worn full time for oneweek after surgery, and must stay dry.

The risk of recurrence after this ganglion seemsto be 5-10%


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GanglionIncision for surgery Dressing worn for the firstweek

l d l k f


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Flexor Tendon Ganglion Risks ofSurgery

Later recurrence of the ganglion in the samelocation

Infection

Nerve injury

Tendon injury

Painful scar


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Mucous Cyst


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Mucous Cyst This is the 4th most common location for a

ganglion cyst.

In this location, the cyst has is also called amucous cyst.


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Mucous CystThere is almost

always a bonespur associatedwith this cyst.


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Mucous Cyst

If the cystgrows close tothe nail bed, a

groove ordefect mayoccur in thenail


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Mucous cyst - Surgery Surgery is done underlocal anesthesia,often in the office

operating room. The bone spur is

removed along withthe cyst

A dressing is wornafter surgery thatneeds to be kept dryfor one week


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Mucous Cyst Surgery


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Mucous Cyst SurgeryThe cyst and spur areremoved A padded dressing is wornfull time for one week


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Mucous Cyst Surgery One week after surgery, the padded

dressing is changed to a band-aid.

Sutures are removed after two weeks. Possible complications include infection,

persistent swelling, loss of joint motion,persistent tenderness, persistent nail

deformity, and recurrence of the cyst.

ganglion presentation

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