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    What is a ganglion cyst of wrist?

    Ganglion is the medical term for overlegs. A ganglion is “an encapsulated tumour surrounded by a membrane in the vicinity of tendons or tendon plates”. Wrist ganglia are tissue cavities near the wrist. The cavities are filled with viscous transparent yellowish liquid. Overlegs are by far the most common benign tumors of the hand. Women between the ages of 20 and 40 are the most frequently affected. Ganglia occur in sixty to seventy percent of cases at the stretch-side wrist. A stalk-like connection to the wrist can often be found. If the overbone is close to the artery, a pulsation can be felt. It is assumed that increased strain on the wrist leads to an increased formation of synovial fluid. The fluid leads to a protrusion of the wrist capsule at a weak point. Overlegs become noticeable as painless swelling that develops over weeks or months. Often the swelling on the wrist is perceived as unattractive, pain is less often the problem. During the examination, the appearance of a ganglion can usually be clearly assigned. A magnetic resonance or ultrasound examination is rarely necessary.

    What is a ganglion cyst?

    A ganglion is a benign fluid-filled tissue cavity of the hand. The causes leading to the formation of a ganglion are unknown. A ganglion has a connection to the joint and is filled with synovial fluid. It can be distinguished from other swellings, e.g. of the tendon sheaths, by careful examination. Excess legs often border directly on important vessels and nerves. They are therefore freed from the important structures of the hand using microsurgical techniques and finally removed. After careful removal via a small access, the patients usually experience a clear alleviation of symptoms. Of all treatment methods, surgical removal is the safest way to ensure that the overbone does not reoccur.

    What are the symptoms of a ganglion?

    A ganglion is initially perceived as a bump on the hand or on the back of the hand. The well-defined swelling can sometimes feel hard, sometimes soft. If the ganglion is close to the artery, a pulsation can be felt. The swelling develops over the course of weeks or months. Often the protrusion on the wrist is perceived as unsightly. It is not uncommon for ganglions to be accompanied by pain. In a separate, as yet unpublished study at the University Hospital and BG Clinic in Tübingen, patients with a wrist ganglion gave the following motives for surgery:

    • 77 percent of cases pain
    • 53 percent pain-related movement restrictions
    • 41 percent aesthetic reasons
    • 13 percent fear of a malignant growth

    How is a ganglion detected (diagnosed)?

    A surgeon with the additional designation of hand surgery can usually clearly assign a ganglion. To do this, the hand surgeon examines the ganglion and palpates it. A ganglion can be distinguished from other swellings, e.g. of the tendon sheaths, by careful examination. Fluoroscopy with a flashlight (diaphanoscopy) will brightly illuminate a ganglion. If there is still doubt, then an ultrasound examination may be helpful. A ganglion that cannot be seen externally and is only revealed by an MRI examination is called an occult wrist ganglion. An intraosseous ganglion, which is a fluid-filled cavity of a bone, can be detected by a computed tomography examination.

    Which doctor can help with a ganglion?

    In any examination, consultation and, of course, treatment, among other things, the doctor’s training and experience are of great importance. Hearsay and a friendly approach are equally important. The professional competence is difficult to assess for a medical layman. Therefore, there is the special and protected professional title of hand surgeon. The specialty of hand surgery includes the detection and treatment of diseases, injuries, malformations and tumors of the hand. In technical terms, ganglions are classified as benign tumors of the hand. Specialists in plastic and aesthetic surgery are allowed to obtain the additional designation of hand surgery after further two years of training. Another professional distinction is the certificate of the Federation of European Societies of Surgery of the Hand (FESSH). This certificate is awarded after passing a comprehensive written and oral examination lasting several days.

    How does a ganglion develop?

    It is assumed that increased stress on the wrist leads to increased formation of synovial fluid (synovia). The fluid causes the wrist capsule to bulge at a weak point. The causes leading to the formation of a ganglion are unclear. The temporal association of two events does not necessarily imply a causal relationship. Observation of a ganglion after an accident, a fall, or a contusion is not sufficient to assume with certainty a cause-and-effect relationship. A causal relationship with pregnancy or rheumatic diseases is not certain. In rheumatism, swelling of the tendon gliding tissue occasionally occurs. This swelling is also called tendon sheath hygroma. There is no connection between wrist ganglia and tendon sheath hygroma.

    Treat ganglions without surgery

    On the Internet you can find a wide range of home remedies and cures. The outdated term for wrist ganglions Bible cyst comes from an unusual treatment method. Attempting to burst a ganglion with the forceful blow of a Bible is not advised. The experience is likely to be very painful, with the ganglion highly likely to recur. Homeopathic remedies are also offered to treat ganglions. The flowers of the Arnica plant have an anti-inflammatory and analgesic effect. Arnica globules D6 have a potency or dilution of 1:1,000,000, which is equivalent to diluting two Voltaren tablets in a bath. Arnica is used in higher concentrations in ointments. The so-called horse ointment contains, among other things, Arnica. Other ingredients in horse ointment include camphor, menthol, methyl salicylate (active ingredient similar to aspirin), and rosemary. A common ingredient in traction ointments (ichthammol) is said to positively influence the healing of inflammatory skin diseases. Betonite, the essential active ingredient of healing earths, reduces the harmful effects of mold toxins (aflatoxins). Scientific studies on the effect of homeopathy, ointments, healing clays or a special diet on wrist ganglia have not been published. The benefits of cold or heat application, certain exercises or massages have also not been proven. The same applies to treatment with ultrasound or laser. Bandages, if worn long term, can lead to joint stiffness and muscle and bone atrophy. A positive effect of bandages or patches on ganglions has not been scientifically proven. Studies on injection treatments have been published. Therefore, it is known that the benefit of injections is far inferior to surgical treatment. The risk of inflammation from an injection into a joint is not insignificant. Inflammation of joints is difficult to treat. Permanent movement restrictions and pain are often the result of joint inflammation. What really helps? Comparison with all other treatment methods shows that ganglions are least likely to recur after surgical removal. After careful removal through a small incision in the skin, affected individuals usually experience significant discomfort relief.

    How is a ganglion cyst removed?

    The outpatient procedure lasts about twenty minutes under local anaesthesia.

    Can a ganglion be removed arthroscopically (through arthroscopy)?

    Yes, ganglions can be removed using the keyhole technique (arthroscopy, joint endoscopy). This involves making four small incisions on the back of the hand through which fine instruments are inserted. For comparison, in the conventional method, the ganglion is removed with a scalpel through an incision about two centimeters long. Since the skin incisions of the keyhole technique are each four to five millimeters long, the procedure does not help to reduce scarring. However, the technical and time requirements of the keyhole method are far greater (Pang EQ, et al., 2017, J Hand Surg Am.). The likelihood of a supra-leg recurring and the risks of both procedures do not differ (Crawford C, et al. 2018, J Hand Surg Eur Vol).

    What are the risks of removing a ganglion?

    Potential complications of wrist surgery include vascular and nerve injury, impaired wound healing, hematoma, inflammation, or complex regional pain syndrome (CRPS). Complication rates of previously published studies range from 0 to 17 percent for surgical removal of ganglions (Kang, L., et al. 2008. J Hand Surg Am, Dias, J. J., et al. 2007, J Hand Surg Eur Vol). In a separate study conducted at the University and BG Clinic in Tübingen, Germany, not a single complication occurred in 70 patients.

    How can you prepare for surgery on a wrist overbone?

    • All your questions about possible complications and alternative treatments should be answered before the operation.
    • Keep nicotine and alcohol consumption to a minimum.
    • Blood-thinning medication (e.g. ASS, Thomapyrin®) must be discontinued at least ten days before the operation after consultation with your doctor.
    • Vitamin preparations (A, E) and dietary supplements (omega-3 fatty acids, St. John’s wort preparations, etc.) must be stopped four weeks before the operation.
    • Surgery limits the ability to travel by air. Therefore, do not plan any professional or private air travel during the four weeks following the operation.
    • At home, prepare ice cubes or cooling pads to cool your skin after the operation.

    What do you need to watch out for after removing a ganglion?

    • Your well-being and the outcome of the operation will be monitored regularly.
    • The elevation and cooling of the hand during the first three days promotes swelling reduction and wound healing.
    • Perform complete fist closure and finger extension exercises several times per hour.
    • From the third postoperative week onwards, several daily circular massages for a few minutes, along and across the course of the scar with oily creams (e.g. Bepanthen® ointment or Linola® fat) help to create inconspicuous scars.
    • The skin threads are removed after ten to fourteen days.

    Can an excess leg return after an operation?

    In a specially carried out follow-up examination of 70 patients at the University and BG Clinic Tübingen, the excess leg came up again in eight percent of the patients. The probability that an excess leg will recur fluctuates in scientific studies between eight and ten percent (Crawford C, et al. 2018, J Hand Surg Eur Vol).

    Tumors on hand and fingers

    Soft tissue tumors on the hand are frequent and usually benign. The hand is a fine clockwork with many structures in a very small space: muscles, tendons, tendon sheaths, ligaments, skin, blood vessels and nerves. In all these tissues cells can multiply unchecked. Both hands correspond to two percent of the total body surface. The hands make up only 1.2 percent of the total body weight. However, fifteen percent of all soft tissue tumors of the body are found on the hand.

    What are giant cell tumors?

    Giant cell tumors are painless swellings of the hand or fingers near tendon sheaths. Affected patients are usually between thirty and fifty years old. The tumour can spread to the joints and bones. Then it is very difficult to remove the tumor completely. In case of suspicion, x-rays and magnetic resonance examinations should be performed. The operation is the treatment of first choice. The removed tissue is typically yellow-brown to grey-white in colour with a flap-like and soft structure.

    What are vascular malformations?

    Vascular malformations are malformations of the vessels that can occur throughout the entire body. The vascular malformations are subdivided according to the flow velocity of the blood flow. Vascular malformations with a high flow velocity transport oxygen-rich arterial blood from the heart. Malformations with a low flow velocity transport oxygen-poor venous blood to the heart. Most vascular malformations are partly arterial and partly venous. At the body surface, malformations are noticeable by a bluish discoloration of the skin. Arterial vascular malformations are characterized by a palpable pulsation and possibly a flow noise. Vascular malformations mainly affect children and adolescents.

    What are schwannomas?

    Schwannomas are benign tumors of the nerve sheaths. The swelling is caused by the uninhibited growth of cells surrounding the nerves. They occur in middle-aged adults. They cause pain or numbness. Touching them can cause an electrifying pain. Schwannomas can be removed from the affected nerve by surgery.

    What are glomus tumors?

    The glomus tumor is a benign malformation of the glomus corpuscle. Glomus corpuscles serve to regulate the skin temperature on the hands and are mainly located under the nails. Five and seventy percent of glomus tumors occur in the hand under the fingernails. Glomus tumors make up only one percent of all hand tumors. They are more common in women between the ages of thirty and fifty and occur spontaneously. Glomus tumors typically manifest themselves through pain that is limited in places and sensitivity to cold. Discoloration of the nail bed is visible under the nail. Occasionally, nail deformations also occur.

    Author’s statement

    Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

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