Dr Steve Carter
Ganglions are a common condition and can occur in any age group. They typically present as a "lump" on the top of the wrist, but can occur on the underside of the wrist (so called volar ganglion), or on the tendon sheath (a millet seed ganglion), or in elderly people with arthritis on top of the end joint of the finger (so called mucous cyst).
No one knows the exact cause. I like to think of it as a build up of pressure in a joint like the wrist and the ganglion is almost like a hernia from the joint.
They are often painless, although the small one on top of the wrist, the so called occult ganglion, can be considerably painful. Typically the patient says they used to be able to do push ups, but can’t anymore, ie they are unable to fully extend a loaded wrist.
Treatment – "hit it with the family Bible", this was an old form of treatment and we will not subject you to this!
- Conservative, advise the patient it is a ganglion and if not painful to adopt a wait and see approach.
- Aspiration and cortisone injection. This may give some relief, but the cysts tend to reoccur.
- If symptomatic we advise surgical excision. There is a risk of recurrence, but at the Cape Hand Clinic this is less than 2% - the average elsewhere is probably 10%.