What is a ganglion?
A ganglion or ganglion cyst in the hand or wrist may present as a lump that can be easily seen and felt or may be detected only on diagnostic image such as ultrasound. Ganglions commonly appear next to a joint or insertion of a tendon. The ganglion is a fluid filled sack that protrudes within an area of the hand that normally has fluid surrounding it. A ganglion can be soft or hard, may or may not be painful, and may grow in size, can completely disappear without treatment or even reoccur after they have been surgically removed.

Why do they occur?
Joints and tendons are lubricated by fluid which is normally sealed within a compartment. As a result of arthritis, an injury, or often for unknown reasons, a leak occurs from the compartment. This leak can function like a one way valve, and fills up like a little “balloon” next to the area of the leak. The fluid is initially watery in consistency. When we use our hands for normal activities, our joints squeeze and create a tremendous pressure in the lubricating compartment – this can pump up the “balloon” leak with so much pressure that it feels as hard as bone and will put pressure on surrounding structures.

Where do they occur?
Typical locations of ganglia are on either side of the wrist, on the palm at the base of the fingers and the back of the end joint of the finger.

Treatment options?
The options for treatment vary based on symptoms, the location and type of ganglion. Conservative treatment is generally indicated as the initial intervention. Conservative treatment such as Hand Therapy may include custom thermoplastic immobilization splints . This immobilization aims to reduce pain by allowing rest to the area to assist in reducing the size of the ganglion. The immobilization period seeks to prevent motion and use of the affected area which can contribute to the ganglion growing in size. This can place further pressure on surrounding structures. Therapeutic ultrasound can give very good relief to the “ache” that typically accompanies Ganglia. Surgical options include removal of the ganglion and cortisone injection.