Surgery on a ganglion cyst of the wrist

When should surgery on a ganglion cyst of the wrist be considered?

When deciding on whether or not to undergo surgery it is important to know that almost half of all ganglion cysts of the wrist recede on their own without any therapy within six to nine months!

Surgery on a ganglion cyst of the wrist should be contemplated when:

  • Experiencing long-lasting or increasing pain in the wrist
  • The ganglion cyst is fairly large and of bothersome appearance (the impairment here may be perceived subjectively)
  • The ganglion cyst applies pressure onto vessels or nerves).

 

What exactly happens during surgery on a ganglion cyst of the wrist?

The way it works is very simple: An incision is placed over the site of the ganglion cyst. The location and length of the incision depends upon the position and size of the ganglion cyst.

The image shows a fairly large ganglion cyst. Therefore the incision had to be a little longer than average. The arrow points towards the lining of the ganglion cyst which becomes visible once the skin and the subcutaneous fat layer were separated.

 

At times the ganglion cyst is located deep inside the actual wrist and becomes visible only after opening up the articular capsule. The image on the left shows such a situation. The extensor tendons are already exposed.

The ganglion cyst itself however, is still not visible. It is located within the articular capsule.

 

What happens at this point of the surgery?

The ganglion cyst is covered with various layers; these layers are being removed in a step-by-step approach. In addition, the ganglion cyst is released from any adhesions to its surroundings.

The image shows a ganglion cyst which is mostly exposed. This ganglion cyst is uncommonly located on the ulnar side of the wrist.

What happens to the fluid within the ganglion cyst during surgery?

In most cases the fluid of the ganglion cyst will drain off of a small opening which oftentimes develops during preparation of the ganglion sheath. Large ganglion cysts may also be punctured during surgery in order to release fluid.

The image shows such a situation: The ganglion cyst which was previously filled with a gelatinous fluid is now empty (red arrow).

On the skin one can still spot residues of the fluid which previously filled the ganglion.

Is the procedure complete once the ganglion cyst was removed?

The pedicle of the ganglion cyst as well as the articular capsule is sealed. In case of larger ganglion cysts drainage is laid into the wound after which it is sealed.

The surgical procedure is concluded after dressing the wound. Some surgeons will use a cast for short-term immobilization.

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