Medial Minimal Hand Grafting

The case

A ganglion is a smooth, round lump filled with thick, clear fluid. It grows out of the lining of a joint or a tendon sheath and is the most common lump in the hand. The usual place is the back of the wrist; the next most common is the palm side of the wrist near the thumb, and small, hard ones form at the base of a finger. They can also appear on the foot, the ankle and around the knee. The cause is often unclear, though an injury or repeated strain may start one. A ganglion can grow and shrink, may disappear by itself, and even a tiny one can be very painful.

Draining a ganglion with a needle is simple, but it usually comes back. Surgery removes the whole sac along with its stalk, the root where it joins the joint or tendon sheath, and a small cuff of the joint lining around that root. Removed this way, about 90% never return. The operation is done through a small cut over the lump, or in some centers through a wrist arthroscope. It is a day-case operation, usually with a nerve block or a general anesthetic, and the lump is sent to the lab to confirm what it is.

Afterward the hand wears a soft, snug dressing, sometimes with a splint, for two or three days, and gentle movement starts soon after. Stitches, if any need removing, come out at about two weeks, and full movement usually returns by six weeks. The main risks are stiffness, a sore scar, irritation of a small skin nerve and, on the palm side of the wrist, injury to the radial artery that often lies right against the cyst.