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Wrist ganglion excision
Wrist ganglion cysts are common, benign fluid-filled lumps that can develop on either side of the wrist and sometimes cause discomfort or restricted movement. Melbourne Hand Surgery offers accurate diagnosis, skilled surgical excision and guided post operative rehabilitation to remove the ganglion and reduce the chance of recurrence.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately two weeks after surgery
Driving
Not for the first few days, and not until wrist movement and grip are comfortable
Post Operative Hand Therapy
Required, commencing one week after surgery
Splinting
A bandage is applied at the end of the operation, and worn for the first week. No splint.
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Light activities within a few days; avoid wrist loading for 8 weeks to minimise recurrence
Surgical removal of a wrist ganglion cyst
A wrist ganglion is a fluid-filled cyst that arises from a joint or tendon sheath, most commonly on the back of the wrist.
Excision surgically removes the cyst along with its stalk back to its origin, to reduce the likelihood of it returning.
Who is this procedure for?
- People with a painful or tender wrist ganglion affecting daily activities
- People whose ganglion is large enough to cause a noticeable lump that is bothersome cosmetically or functionally
- People whose ganglion limits wrist movement or grip
- People who have had the ganglion aspirated (drained with a needle) previously and it has recurred, and who want a more definitive treatment
What does the surgery involve?
Surgery involves an incision over the ganglion, carefully dissecting it away from surrounding tendons, nerves and blood vessels, and following its stalk down to the joint or tendon sheath it arises from, where it is removed at its base. This helps reduce (though does not eliminate) the chance of recurrence, since ganglions can recur even after apparently complete excision.
Alternatives to surgery
Surgery is one option for a wrist ganglion. Depending on your situation, the alternatives may include:
- Observation: many ganglions are harmless and some resolve on their own over time without any treatment
- Aspiration: draining the cyst with a needle under ultrasound guidance, which can relieve symptoms but has a high rate of recurrence since the stalk is left behind
What happens if left untreated: a ganglion that is not causing symptoms can safely be left alone; some will resolve spontaneously, while others persist or slowly enlarge without necessarily causing harm.
Dr Tomlinson will discuss which options suit your specific situation at your consultation.
Frequently Asked Questions
Where will my surgery be done?
What type of anaesthetic will I require?
Dr Tomlinson performs this procedure under general anaesthetic. If you are interested, she will discuss the technical reasons for this during your consultation.
How much time will I need to have away from work?
This depends on what your job involves. Desk-based work can usually resume within a few days. Manual work or activities that load the wrist may need to be modified for a some weeks. Dr Tomlinson will give you advice tailored to your job at your consultation, and your hand therapist will guide you in return to work planning.
When will I be able to drive again?
Multiple things affect this: which hand (dominant or non-dominant) was treated, your level of post operative discomfort (which influences 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 to two weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 1 week 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 a general anaesthetic. In line with current ANZCA guidance 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.
How long will I need to wear a splint?
A bandage dressing is usually all that is needed.
Will I need to see a hand therapist afterwards?
Dr Tomlinson recommends that all patients see a hand therapist after wrist ganglion excision, for assistance with range of movement exercises and advice on isometric strengthening of the wrist. By addressing the biomechanics of your wrist and achieving a strong wrist during your rehabilitation you will reduce the likelihood of ganglion recurrence and wrist pain in the future.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. 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 this surgery
In addition to the general risks of hand surgery, this specific procedure includes the risks of:
- recurrence of the ganglion (which occurs in a proportion of cases – thought to be around 10% in dorsal wrist ganglions and 30% in volar wrist ganglions – even after apparently complete excision),
- stiffness of the wrist or loss of movement,
- scar tenderness,
- nerve entrapment in the scar,
- persistent wrist pain, and,
- depending on the ganglion’s location, a small risk of injury to nearby nerves, tendons or blood vessels during dissection.
Anaesthetic
Your anaesthetist will discuss the specific risks of general 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 hand may have numb areas during this time.
First week
Keep the bandage dry and intact until your hand therapy appointment. You may use your hand for light activities, but listen to your hand and avoid anything that causes pain, such as lifting or gripping. You should find that your hand function is better each day after the early phase of swelling/bruising and post operative discomfort passes.
Second week
The wound is usually well settled, though some swelling and tenderness at the surgical site is normal. Gentle wrist movement is encouraged unless otherwise advised.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months. The scar will feel tight and firm, and often that firmness may create concerns that the ganglion has recurred. 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 return to full activities within 2-4 weeks. Recurrence, if it occurs, usually becomes apparent within the first year and would be discussed with you should it happen.
Want to know more about Wrist Ganglion Excision?
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.