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Ganglion excision - open or arthroscopic (keyhole)

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Wrist ganglions are small fluid-filled sacs that grow out of the tissues surrounding the joint. It occurs when the fluid that normally resides in the wrist leaks through small defects in the walls of the joint to form a bubble, or cyst, under the skin. This is called a ganglion formation.

 

Ganglions can be removed surgically in a traditional open procedure or arthroscopically (key-hole). When using key-hole surgery, Kemble makes a couple of small incisions and uses a fibreoptic telescope to clearly see the inside of the wrist joints. The fluid inside the ganglion is sucked out and decompressed through the joint

 

After surgery, the incisions will be sutured closed and a waterproof dressing applied. A backslab plaster or bulky dressings will also be applied during surgery.

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Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

 

  • Please keep all dressings/bandages intact and dry until a post-operative review by Kemble or your hand therapist. A plastic bag tied around your forearm to prevent the wrist from getting wet can be used during showering, or alternatively, one-handed baths can be taken. Kemble will review the wound and advise when it is safe to get it wet.

  • Keep the arm elevated at all times if possible. This is particularly important in the first 5-7 days following surgery. This helps reduce swelling.

  • When seated or lying down, use a pillow to prop the arm up. 

  • Even with the dressing/splint on, patients should continue to move their fingers immediately after surgery to avoid stiffness.

  • It is normal to have some tingling, numbness or weakness following the procedure. This should wear off in the first day or two.

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At 10-14 days following surgery

  • Removal of post-operative dressings and primary dressing of wound;

  • Wound check, dressing change and removal of sutures as necessary;

  • Apply tubigrip (or similar) to wrist to reduce post-operative swelling;

  • A thermoplastic splint or a brace will be provided by the therapist;

  • It is recommended patients commence a gentle range of motion without the splint, but must remain in splint all other times;

  • Continue finger movement, elbow movement, shoulder movement;

  • Patients can undertake light functional tasks with their hand (e.g. eating, dressing, using phone).

  • Pain is normal when the recent is moved in the first few weeks past surgery;

  • Scar massage is also to begin at this stage.

 

At 6 weeks post-operatively (Review appointment):

  • Commence strengthening and conditioning exercises of the wrist and upper limb

  • Cease splint

 

Return to activity / sports:

  • The speed of recovery and the ability to return to sports or hobbies is different for everyone. It is also dependent on a therapist's input and assessment of healing.

  •  Once sufficient healing has occurred, patients can increase weight-bearing through the arm and gradually return to sports. Kemble will advise when the wrist joint has recovered sufficiently for a safe return to sport or other activities and hobbies.

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Possible complications of this procedure

  • area of numbness and nerve irritation

  • Recurrence of ganglion – up to 20% in adults and up to 50% in children

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