Transcript GANGLION CYSTS

GANGLION CYSTS
What is a ganglion cyst?
 A ganglion cyst is the most
common soft tissue mass in the
hand and wrist.
 These cysts are sacs that arise
from a joint or tendon sheath
and become filled with a
gelatinous fluid.
 It is believed the cysts are a
result of a weak spot or
degeneration of tissue lining a
joint or tendon sheath.
Common types of ganglions
 DORSAL CARPAL GANGLION CYST
 Most common location of a ganglion cyst.
 Often arises from a weak spot in the scapholunate ligament on the
back of the hand.
 VOLAR GANGLION CYST
 2nd most common location of a ganglion cyst of the wrist.
 Often arises from a weak spot in either the radiocarpal joint or STT
joint
 RETINACULAR CYST
 This variant of a ganglion cyst occurs on the palm side of the hand
at the joint where the fingers join the palm.
 These cysts arise off the A1 or A2 pulley of the flexor tendon sheath.
 MUCOUS CYST
 These are ganglions that occur on the back of the finger at the DIP
(distal interphalangeal) joint, the joint closest to the fingernail.
 Most often are associated with underlying osteaoarthritis at this
joint.
Treatment options
 Splints
 May be used to provide pain relief by resting the offending
joint or tendon sheath
 Anti-inflammatory medications
 Can be taken orally to reduce swelling and relieve pain
 Try to modify or avoid activity that causes pain
Aspiration of the cyst
 In the office, it can be attempted to puncture the cyst
with a needle and aspirate the fluid from it.
 This may eliminate the cyst completely, but there is a high
rate of recurrence following this procedure.
Surgical options
 Ganglion cysts are often removed
for a variety of reasons, inluding:
 Pain relief
 If causing limitations to range of
motion
 Aesthetically unpleasing
 Specifically in the case of mucous
cysts, it is important to surgically
remove them if they rupture. This is
to prevent infection of the
underlying joint.
 Sometimes an MRI is ordered to
confirm origin of the stalk of the
cyst so we can ensure this area is
addressed intraoperatively.
Surgical treatment
 Surgical treatment for this involves removing the cyst sac
and addressing the underlying cause, such as ablating
the weak spot in the ligament or removing the bone spurs
from an arthritic joint.
 This is an outpatient procedure and takes about 15-20
minutes to perform.
Surgery details
 Dorsal carpal ganglion cysts:
 This procedure is performed under regional
anesthetic, which involves a nerve block at the
shoulder.
 Near the location of these cysts there is a nerve
called the PIN (posterior interosseous nerve). Its
function is to provide pain fibers to the wrist
capsule and can be a contributing factor to
pain in this location. It is also removed during
the procedure.
 Volar carpal ganglion cysts:
 This procedure is performed under regional
anesthetic, which involves a nerve block at the
shoulder.
Surgery details
 Retinacular cysts:
 This procedure is performed under local anesthetic, involving an
injection near the site of the cyst.
 Mucous cysts:
 This procedure is performed under local anesthetic, involving an
injection that will the numb the finger.
 These cysts can thin the skin and sometimes require transfer of
nearby skin to cover the defect.
 In all situations, we are able to
give you some sedative
medication through an IV to
keep you comfortable.
Risks
 Anesthetic
 Infection
 Numbness
 Recurrence
Post-operative care
 A soft dressing is applied after
surgery. You will be able to use
your hands for light activity later
that day.
 Keep the surgical dressing and
incision clean and dry. After 48
hours you may remove the soft
dressing and your incision may
get wet in the shower, but no
soaking. Apply a band-aid to
keep the incision clean if
necessary.
 Approximately 10-14 days postoperatively you will return to Dr.
Foad’s office for a follow-up visit
and suture removal.
GANGLION CYSTS
POST-SURGICAL FAQ’S
When do I see Dr. Foad after surgery?
You will return to see Dr. Foad for your post-op visit about
10-14 days after surgery.
When can I use my hand?
You will be able to begin using your hands for light
activities usually the night of surgery. You will have a soft
bandage on the hand that leaves your fingers and wrist free
to move. You can perform simple functions such as
feeding yourself, brushing your teeth, carrying a cup of
coffee, etc. and continue to increase those as tolerated.
How do I care for my dressings?
You will have a soft bandage (not containing any hard cast
material) after surgery. This should not get wet. You will
be able to remove this on your own 48 hours after surgery.
At that time you can cover the incision site with a band aid
to keep it clean.
When may I shower or bathe?
You may begin to shower or bathe as soon as you like. If
the original surgical dressing is still on, take care not to get
it wet. After 48 hours, please remove your soft dressing.
You may wash your incision in the shower, however, do
not submerge the incision underwater for an extended
period of time, such as in a pool or hot tub.
When do the stitches come out?
Typically, Dr. Foad uses dissolvable stitches that are under
the skin and do not require to be removed. In some cases
that external stitches are necessary, they will be removed at
your post-op visit 10-14 days after surgery.
What if my pain medication causes itching
or nausea?
It is not uncommon for pain medications to cause these two
side effects. If you experience itching you may take
Claritin or Benadryl to help with this. If you are
experiencing nausea, a prescription for Phenergan (aka
promethazine) was given for this purpose on the day of
your procedure. Remember to take your pain medication
with food to diminish the potential for nausea.
What about swelling?
Swelling is quite common following these procedures. Do
your best to keep the hand elevated above the level of your
heart. Moving the fingers to open and close into a tight fist
is also encouraged. Taking ibuprofen (Advil, Motrin) in
addition to your pain medication will help with swelling
(note: do NOT take more acetaminophen/Tylenol as it is
already a component in the prescriptions you were given)
When may I drive?
You may begin driving again when you feel comfortable
behind the wheel AND you are no longer taking any of the
narcotic pain medications. If you would feel comfortable
driving next to yourself on the road, it is probably safe for
you return to this activity.
When can I go back to work?
It depends on the type of work you do. Those with jobs
that are more sedentary and do not require heavy loads on
the hands are often able to start returning to their duties
within 1-2 weeks. Jobs that involve extensive heavy lifting
and strain on the hands may take 3-4 weeks before they are
able to return to work functions more normally. This is
something quite unique to every patient’s situation and can
be discussed more specifically with Dr. Foad at your office
visit.