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Ganglions

Ganglions are the most common soft tissue lumps in the hand. They are generally innocent lumps that form a particular route at a joint or a tendon sheath. They are much more common in ladies (three to one). The vast majority occur in young adulthood.

There are four common sites for ganglions

  1. The dorsal wrist ganglion - A lump that occurs on the back of the wrist a little bit more towards the thumb side than the little finger side. (See picture 1 below.)
  2. Mucous cyst - This occurs at the base of the nail and is common in arthritic fingers. Sometimes these do cause a groove on the nail. (See picture 2 below.)
  3. Volar wrist ganglions - These are at the front of the wrist, just over the position where you would take someone's pulse. (See picture 3 below.)
  4. Seed ganglions - These are hard, tiny ganglions present at the base of the finger. You generally cannot see these but you can feel them, particularly when gripping the steering wheel.

Why ganglions occur is unknown. They generally occur from damaged joints where the amount of fluid in the joint increases and is extruded through a weakness in the joint capsule, forming a ganglion. They can also occur when there are damaged ligaments and defects in tendon sheaths.

Symptoms
Most commonly ganglions are referred to hand surgeons because of the unsightliness of the lumps either on the back or front of the wrist or at the end of the fingers. A dorsal wrist ganglion can give a pain going up the back of the wrist associated with a lump itself irritating the tendons on the back of the wrist because these tendons are attached to muscles the pain can go up the back of the forearm. Commonly mucous cysts are unsightly and can also cause ridging of the nail (see picture 2) and they can also discharge a sticky jelly like material which can be very irritating. These are very superficial and can sometimes get infected. Volar wrist ganglions are slightly less painful but when they are painful can be associated with arthritis in the joint under the thumb called the STT joint. Seed ganglions tend to cause irritation and pain when people grip things such as steering wheels and it is generally not feasible to see these are they are not big enough to be visible but are certainly palpable with the finger.

There are four treatments for ganglion

  1. Nothing - Nobody ever died from a ganglion. They can sometimes disappear by themselves. The only real reason for treating a ganglion is if it pressing, or obstructing a nerve.
  2. The religious treatment - The age-old treatment of hitting it with a bible. (Obviously it is not necessary to use a bible!) One can apply simple pressure and burst them, as one can do a spot!
  3. Aspiration - This is drawing off of the fluid with a needle. After the aspiration can be injected with some steroid and this slightly reduces the recurrence rate.
  4. Surgery - Unfortunately ganglions tend to recur. Recurrence after bursting it (with whatever means!) is about 90%. Recurrence straight after aspiration is some 50% or 60%. The recurrence rate, even after surgery, is recorded as being 25%.