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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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Flexor Tendon Sheath
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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Flexor Tendon Sheath
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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Flexor Tendon Sheath
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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Flexor Tendon Sheath
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.
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