What is a ganglion cyst and how is it removed?

Transcript

Let's talk about ganglion wrist surgery. First let's look at the locations of the cyst. Most common is on the, around the wrist, on the, on the top side or dorsal side, the volar side as you can see here, out at the tip of the digit near the nail bed, and at the base of the finger. So these are four common locations.

But first let's talk about the wrist, and the common, most common is on the dorsal side or top of the wrist. This, make no mistake about it, this is a large cyst here. They're not always this big. This literally looks like a golf ball. But in other cases these can fluctuate in size more with activity. As you can see, a large one on top that's, uh, filled with fluid. With rest this can actually drain into a smaller, less painful cyst, so they can fluctuate over time.

Now commonly the patient will come in with a several year history of wrist pain, pain with activity such as pushing off, such as in yoga, such as push, doing just simple push-ups, or just simply push, pushing off of a chair from a sitting position. What happens is this cyst is like a balloon in a hinge. When you push off it, it gets in the hinge and causes discomfort.

Now an MRI is usually obtained to, to assess the situation. You can see this fluid filled, uh, cyst on the back of the wrist right behind the bones of the wrist, and as you can see, when it goes back it can cause this kind of balloon, balloon in a hinge phenomenon.

Now about 50% of cases that MRIs are obtained for a cyst, the MRI doesn't pick, pick it up, because it's such a small cyst in many cases that it doesn't visualize on the cuts on the MRI. But we actually take the cyst out, send it to the lab, and they confirm it to cyst. So a lot of people don't think the MRI is the end all be all, but it doesn't always show the problem.

But it's also worthwhile getting the MRI, because frequently it'll show ligament or cartilage injuries that we didn't even know the patient had and can address at the same time.

Now if you look here, this is an animated picture of really what's going on. This is a sac coming out with a root right out of the main ligament in the wrist, usually from between the scaphoid and the lunate bones, called the scapholunate ligament. We go in and we remove this cyst, cutting around the base of it and take the cyst out, as you can see it's missing here.

Now let's take a look at actual patient undergoing this procedure. You can see the wrist is bent, prominence in the left hand side, uh, denoting a cyst, and on the right hand side you can see this gelatinous filled sac, fluid filled sac that we go in and take out. Now at the same time we'll frequently stick in an arthroscope, a 2mm scope, through that wound to look around. It's not uncommon to actually see a cartilage injury.

So after this surgery, assuming it's just a simple cyst removal, we'll put the patient in a brace for about three to four days. The patient comes back for the initial post-operative, uh, evaluation. We take the splint off, start you moving right away. Very few pain pills are even needed following this simple 15 minute procedure.

So after this, after we start, after you come back to the office, we start rehabbing you. It's about a six week recovery start to finish before all the soreness dissipates and you're back to full activity. There's about a 5% recurrence rate, so taking the cyst out, 5% of the time it can come back. For more on this condition and many other conditions, please visit the Hand and Wrist Institute website.