Question for Physiotherapists
QUESTION | My hairdresser has a ganglion on the anterior aspect of his
wrist just below the thumb. His hairdressing activities aggravates it such to
increase the size rather than causing pain. Are there any solutions or should he
just leave it alone? I gather surgery is tricky with the closeness of nerves
and vessels in the area.
ANSWER | A ganglion
is a fluid collection due to an underlying or nearby abnormality of some sort.
For example, this may be a tear in a tendon sheath or degeneration of a joint
capsule. The body's response to injury or degeneration is often to bring fluid
into the area, which can then collect as a ganglion within a membrane sheath.
As this ganglion increases in size, it can sometimes be visible at the skin surface
as it bulges upwards towards the region of least resistance.
As you have
noted, certain activities may increase the local inflammation and therefore
increase the fluid accumulation, leading to an apparent increase in the size of
the ganglion. Sometimes, the patient may experience pain in the region. It is
important clinically to determine whether this pain is coming from the
underlying condition itself or from the pressure of the ganglion on the
ganglion is not bothering a patient too much, there is no harm in leaving it
alone. It is difficult to predict whether it will increase or decrease in size
ganglion is bothersome, either in terms of pain or appearance, then the initial
treatment is usually an aspiration of the fluid and an injection of steroid
into the region to try to quell the underlying cause and to stop the ganglion
from reforming. This is a very simple procedure, but has a recurrence rate of
over 50%. The location that you have described does indeed contain important
neurovascular structures, such as the radial artery and the median nerve. For
this reason, I do not personally aspirate a ganglion here, but prefer to send
to a radiologist to perform under ultrasound guidance, where the structures can
be seen and avoided.
aspiration and injection fail to relieve the ganglion and symptoms, or if the
patient prefers a single procedure instead, then surgical excision may be
performed. The ganglion and its membrane sheath are excised and followed to the
source, where the underlying structure is debrided or repaired as required.
Post-operatively, the patient needs to keep this area dry until the wound has
healed and the sutures have been removed. Generally, time back to activities
ranges from a few days for light office work up to 3 months for heavy
construction work. The recurrence rate after surgery is about 15%.
correctly point out, it is important that the nerves and vessels in the area
are avoided during surgery, but surgery is often done in close proximity to
nerves and vessels, and it is therefore important that this is performed by a
surgeon who understands the anatomy of the region, uses appropriate optical
magnification and is gentle with the soft tissues.
|Dr Kwan Yeoh
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