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Flexor tendon sheath ganglion excision
Flexor tendon sheath ganglion excision removes a small, firm lump that forms on the pulley of the flexor tendon, most often at the base of a finger or in the palm, and can cause tenderness when gripping. Surgical excision removes the cyst to relieve discomfort and restore comfortable use of the hand.
At a glance
Anaesthetic
Local anaesthetic - suitable for most cases given the small, localised nature of the lump
Where
The Avenue Hospital
Day case
Home the same day
First post operative review
Approximately one week after surgery
Driving
Not for the first few days, and not until finger movement and grip are comfortable
Post Operative Hand Therapy
Not usually required
Splinting
A light dressing is usually all that is needed; splinting is not routinely required
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Light activities within a few days; full grip activities usually within 1-2 weeks
Surgical removal of a ganglion arising from the flexor tendon sheath
A flexor tendon sheath ganglion is a small, firm, pea-sized lump that arises from the sheath surrounding the flexor tendon at the base of the finger, in the palm. Excision removes the lump along with a small portion of the sheath it arises from.
Who is this procedure for?
- People with a tender lump in the palm that is uncomfortable with gripping (a common presenting complaint, as these ganglions are often tender directly over the lump when gripping an object)
- People whose lump is bothersome or enlarging
- People who want a definitive diagnosis and treatment, as these lumps can occasionally be confused with other soft tissue lumps
- People who have had the lump aspirated previously without lasting improvement
What does the surgery involve?
Surgery involves a small incision in the palm over the lump, carefully identifying and protecting the underlying flexor tendon and digital nerves, and removing the ganglion together with a small window of the tendon sheath it arises from. This is usually a quick procedure performed under local anaesthetic with or without sedation.
Alternatives to surgery
Surgery is one option for a flexor tendon sheath ganglion. Depending on your situation, the alternatives may include:
- Observation: if the lump is not particularly bothersome, it can be safely left alone
- Aspiration or firm pressure: occasionally used, though these ganglions are typically firmer and less amenable to aspiration than wrist ganglions, and recurrence after aspiration is common
What happens if left untreated: the lump is benign and not left untreated does not typically cause harm, though it may remain tender with gripping activities.
Dr Tomlinson will discuss which options suit your specific situation at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
Why might I choose local anaesthetic rather than sedation or a general anaesthetic?
A procedure under local anaesthetic avoids the risks and recovery of sedation or a general anaesthetic. You don’t need to fast beforehand, you can eat and drink normally, you recover quickly, and you usually go home soon afterwards. For many people it’s also less expensive and more convenient.
How much time will I need to have away from work?
Most people can return to desk-based work within a day or two. Manual work involving repetitive gripping may need to be modified for a week or so. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for one week after the procedure.
When can I do a full day of administrative or desk work?
Often from a couple of days after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions. If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.
How long will I need to wear a splint?
Splinting is not routinely required. A simple dressing protects the wound while it heals over the first week or two.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Hand therapy is not routinely needed after this procedure, as it is a small, localised excision with minimal disruption to surrounding structures.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of excision of a flexor tendon sheath ganglion
- Irritation or temporary injury to the digital nerve or artery, which run immediately alongside this type of ganglion
- Recurrence, though this is uncommon after surgical excision
- Temporary restriction of finger movement, usually resolving within a few weeks
- Tenderness over the scar at the base of the finger
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your finger will be numb during this time.
First week
Keep the dressing dry and intact until your post-operative review. Use your hand for light activities, but listen to your hand and avoid anything that causes pain, such as lifting or gripping. Scar sensitivity and discomfort with lifting and gripping are expected in the first few weeks. After the first 2-3 days you should find that your hand function is better and your discomfort less each day.
Second week
The wound is usually healing well. Grip strength typically returns quickly once the wound has healed, though the scar itself may remain tender to firm pressure for some weeks.
6 weeks
Deep-pressure tenderness over the wound can persist for some months.. The scar may feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Most people are back to full grip activities within 2-3 weeks. Scar tenderness in the palm can take longer, sometimes several months, to fully settle.
Want to know more about Excision of Flexor Tendon Sheath Ganglions?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.
See also: Finger and Hand Ganglion Cysts, Wrist ganglion, and Ganglion cyst excision (finger, hand).