Potential risk during surgery on a ganglion cyst of the wrist

What are the potential risks that may arise during surgery on a ganglion cyst of the wrist?

Hereafter are a few examples (in excerpts) of some important complications and problems that may occur in connection with surgery on a ganglion cyst of the wrist:

Dystrophy risk (Sudeck´s atrophy, Complex Regional Pain Syndrome (CRPS):

In isolated cases severe mobility dysfunctions accompanied by soft tissue swellings along with significant decalcifications manifesting in the bones of the hand may arise after surgery or aspiration on a ganglion cyst of the wrist (CRPS, Sudeck´s atrophy, algodystrophy).

A typical symptom of this condition in an advanced stage is the patchy decalcification of the bones in the hand.

The image shows a Subdeck’s atrophy (CRPS) with severe swelling on the dorsum of the hand.

Those patients who experience persisting pain during post-surgery treatment are particularly at risk to develop Sudeck´s atrophy. Frequently patients experience a sensation of a “too-tight-dressing” during this time.

Sudeck´s atrophy may generally occur after any type of surgery or injury to the hand! This includes so-called “minor” procedures such as the removal of a ganglion cyst.

Since the cause for Sudeck´s atrophy is unknown, no physician can really be certain to avoid this potential surgery-related risk.

Infection, impaired wound healing:

Infections or wound healing impairments on the surface of soft tissue typically can be addressed through simple measures such as the early removal of stitches, administration of antibiotics, etc.

Fast response times after detecting first symptoms such as redness, in most cases will prevent the infection to advance into deeper layers of the wrist.

Deep infections reaching into the wrist are not too common; however, they are extremely problematic. Second interventions and permanently remaining dysfunctions may be the result thereof.

 

How can a patient find out whether he/she suffers from wound healing impairment?

The pain after the removal of a ganglion cyst typically should recede a few days after the procedure.

The mobility of the fingers and the thumb increases and the patient will experience less post-operative pain during his/her night rest.

[the_ad id=“1281″]If, however, after first signs for a positive recovery new pain flare-ups occur several days after surgery and if these are also accompanied by a decrease of mobility in the thumb, the other fingers or the entire hand, the patient should immediately consult an experienced hand surgeon, orthopedist or trauma surgeon to seek help. (The wound can best be assessed by the surgeon who performed the procedure!)

 

It is of particular importance to quickly seek help if the wound turns red, swells up or the experienced pain is of throbbing nature as the possibility of an infection must be ruled out.

Should the suspicion substantiate that indeed the patient developed a deep-lying infection, the wound requires immediate opening. A second intervention in such a case should not be procrastinated.

Mobility impairment of the wrist:

Surgery on a ganglion cyst of the wrist usually does not require immobilization (in some cases a brief immobilization period may be appropriate).

The early pro-active exercising of the fingers and the thumb interphalangeal joint (without straining!) lowers the risk to incur wrist or finger mobility limitations later on.

An experienced physician should apply the dressing after surgery in such fashion that allows for pro-active mobility.

Nonetheless each surgical procedure to a hand due to pain and swelling may lead to a permanent limited mobility. After the removal of a ganglion cyst, a limited mobility of the wrist in the bending direction may be observed frequently.

Injury of cutaneous nerves within the operating surface of the ganglion cyst

On an exceptional basis, a larger cutaneous nerve which runs in the thumb may be injured during surgery. The nerve may either get cut or “just” pinched.

If the nerve is just compressed, the numb sensation will let up – typically on the extensor side of the thumb or the base of the thumb – allowing the local nerve pain to recede over a period of months.

If, however, the nerve was cut an almost spot-like “electrifying” bruise will form within the scar. A neuroma develops leading to the loss of cutaneous sensitivity within the area supplied by the damaged nerve.

The injury of nerves may be at cause for the development of a very particular pain pattern (CRPS II).

 

Will the scar in connection with surgery on a ganglion cyst hurt for a long time?

Scars after surgery on a ganglion cyst just as any other scars on hands will remain sensitive for a longer period of time than scars on other areas of the body. Excessive scarring (keloidal scars) is rather uncommon on hands.

Most scars connected to the removal of a ganglion cyst typically will turn pale and nearly be invisible after approximately one year.

After the first months however, the scar appears slightly thickend, sensitive to touch with a mildly reddish-livid discoloration.

 

Is there a possibility for post-hemorrhaging after surgery on a ganglion cyst?

Yes, but this too is a rather uncommon surgery risk. Chances for severe post-hemorrhaging, however, are higher when operating on a ganglion cyst in proximity of the radial artery.

In isolated cases the radial artery or a larger vein may be injured during surgery.

The image to the left shows the removal of a ganglion cyst located in proximity to the radial artery (see arrow).

The radial artery was released from the sheaths of the ganglion cyst with the help of a clamp.

In case bleeding and swelling of the wound becomes excessive within the first days after surgery, it may be necessary to re-open the wound to seal the injured blood vessel.

It is possible to micro-surgically restore the radial artery in the event it was injured.

Patients particularly at risk for post-hemorrhaging after surgical treatment of a ganglion cyst of the wrist are those who use medication that impacts the blood clotting (for example Aspirin®, ASS 100®, Plavix®, Clopidogrel®, Marcumar®… ).

Please be sure to inform your anesthetist as well as your surgeon if you take one of the aforementioned medications or any other medication that has an impact on blood clotting.

 

Is it possible that the ganglion cyst may return even after surgery?

Yes! In medical literature the relapse (recurrent cyst) quota varies considerably. Most data shows a quota of around twenty percent, some source even reports on a quota of up to forty percent.

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