Surgery is recommended when the patient feels significant pain or when the cyst interferes with activity. It is also recommended if the ganglion is compressing nerves in the wrist, since this can cause problems with movement and feeling in the hand. Surgery is usually done using regional anaesthesia, which means only the arm is put to sleep, but it can also be done under a general anaesthesia in which you go to sleep.
To remove a dorsal wrist ganglion, a small incision is made in the back of the wrist. The tendons that run across the back of the wrist and into the fingers are retracted (or moved) out of the way. This allows the surgeon to see the ganglion and follow it down to where it attaches to the wrist capsule. Once the surgeon locates this stalk, the entire ganglion is removed, including the area where it attaches to the joint capsule. The joint capsule may or may not need to be repaired with sutures. Finally, the skin incision is closed with fine Monocryl sutures. You will be placed in a POP splint which will be removed at one week post operation by the outpatient nurses.
Excision is the most common surgery for volar wrist ganglions. Removing the ganglion is usually effective if the stalk that connects the cyst to the joint capsule and a bit of the surrounding capsule are removed. The surgical procedure is basically the same, except the volar ganglion is usually very close to the radial artery (the artery in the wrist used to feel someone's pulse). In some cases, the volar ganglion even winds around the artery. This makes removing the ganglion a bit more difficult. The surgeon must be careful to protect the artery, while at the same time removing the cyst down to the joint capsule, just like with the dorsal ganglion. The surgical wound is closed with Monocryl suture. You will be placed in a POP splint which will be removed at one week post operation by the outpatient nurses.
A dressing is applied to the wrist and forearm as well as a POP splint. You will be encouraged to move your fingers and wrist soon after surgery. Stitches and POP splint are removed one week post operation. Your surgeon may refer you to see a hand physiotherapist and exercises should be continued until you can move your wrist normally. Your surgeon will see you at 6 weeks post operation to check your progress.