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Ganglion Cyst Removal

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Dr Jacqueline Tan

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Ganglion cyst removal is a surgical procedure used to treat non-cancerous, fluid-filled lumps that commonly develop near the tendons or joints of the wrist and hand. These cysts, filled with thick joint fluid and surrounded by a tough sheath, may cause pain, numbness, or restricted movement if they compress nearby structures or are located in areas affecting mobility. The procedure focuses on removing the cyst to address symptoms and reduce recurrence.

Indications for Surgery

Ganglion cyst removal is recommended when the cyst causes discomfort, functional limitations, or other health concerns.

  • Persistent Pain or Discomfort: Ganglion cysts may cause pain, particularly when pressing on nearby nerves or during joint movement. Surgical removal alleviates these symptoms.
  • Reduced Joint Mobility: Cysts located in areas affecting tendon or joint function can limit normal movement, making certain activities difficult.
  • Nerve or Vessel Compression: Numbness, tingling, or impaired circulation can occur when a cyst compresses surrounding nerves or blood vessels. Removing the cyst can relieve these symptoms.
  • Cosmetic Concerns: Some individuals may find visible cysts bothersome and prefer to have them removed.
  • Recurrent or Persistent Cyst: If the cyst returns, grows larger, or remains unresponsive to non-surgical management, removal is often recommended.

Benefits of Ganglion Cyst Removal

Ganglion cyst removal offers a number of benefits for individuals experiencing discomfort or functional issues caused by the cyst. These include:

  • Symptom Relief: Pain, numbness, or tingling caused by the cyst pressing on nearby structures can be resolved with surgical removal.
  • Restored Function: Joint mobility and the ability to perform routine activities improve after removing cysts that impede movement.
  • Lower Recurrence Risk: Surgical removal, including excision of the cyst stalk and membrane, reduces the likelihood of the cyst returning compared to aspiration or other non-surgical treatments.

Surgical Methods

There are two primary surgical approaches used for ganglion cyst removal, each suited to specific cases.

Open Excision Surgery

This method involves making an incision directly over the cyst, allowing the surgeon to remove the cyst along with its stalk and surrounding membrane. It is effective for large or deep-seated cysts, providing a thorough removal and a lower recurrence rate.

Arthroscopic Surgery

This is a minimally invasive technique in which a small camera and specialised instruments are inserted through tiny incisions to remove the cyst. This approach causes less tissue disruption, potentially leading to a quicker recovery. However, it may not be suitable for all cyst types or locations.

Preparation for Surgery

Medical Evaluation

A review of the patient’s medical history and imaging tests, such as X-rays or ultrasound, helps determine the cyst’s size, location, and whether other conditions, such as bone or vascular abnormalities, are present.

Medication Adjustments

Patients may need to temporarily stop certain medications, such as blood thinners, to minimise the risk of excessive bleeding during surgery.

Pre-operative Guidelines

Fasting for several hours before surgery is typically required if anaesthesia is used. Patients should also keep the surgical area clean and free from lotions or other products.

Skin and Joint Preparation

Patients are often instructed to avoid activities that strain the affected joint, as excessive movement can exacerbate swelling before surgery.

Step-by-Step Procedure

Anaesthesia Administration

The type of anaesthesia used depends on the size and location of the cyst. Local anaesthesia is commonly applied for smaller cysts, while general anaesthesia may be used for larger or more complex cases. This ensures the patient remains comfortable and pain-free throughout the procedure.

Incision

In open surgery, a single incision is made directly over the cyst to allow for its removal. For arthroscopic procedures, small entry points are created for the insertion of a camera and specialised instruments to access and remove the cyst.

Cyst Removal

The surgeon carefully excises the cyst, along with its stalk and surrounding membrane, to minimise the risk of recurrence. During the procedure, the joint or tendon sheath is examined for any signs of inflammation or other abnormalities that may require attention.

Wound Closure

Once the cyst is removed, the incision or entry points are closed using sutures or adhesive strips. A sterile dressing is applied to protect the area and support the healing process.

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Post-Surgical Care and Recovery

Immediate Care

After surgery, the surgical site is observed for swelling, bleeding, or signs of infection. Pain relief medications are provided to manage discomfort, and antibiotics may be prescribed to reduce the risk of infection.

Recovery Process

Patients should avoid strenuous activities to allow the surgical site to heal. Depending on the surgeon’s recommendation, specific rehabilitation exercises may be required to restore mobility and strength. Most patients can resume light activities within 1-2 weeks, while complete recovery typically takes 4-6 weeks, depending on the complexity of the procedure.

Follow-up

Follow-up appointments are scheduled to monitor the healing process and check for any recurrence or complications. Sutures are usually removed within 10-14 days, depending on how well the wound is healing.

Potential Risks and Complications

While ganglion cyst removal is generally safe, it does carry some risks, such as infection, scarring, and joint stiffness. There is a small chance of recurrence, even with thorough surgical excision. Rarely, nearby nerves or blood vessels may be affected during the procedure, leading to temporary or permanent changes in sensation or mobility. Aspiration, while non-surgical, has a significantly higher recurrence rate and an increased risk of infection compared to surgery.

Frequently Asked Questions

What are the risks of leaving a ganglion cyst untreated?

Ganglion cysts are typically harmless if they do not cause pain or limit movement. However, they may grow, fluctuate in size, or press on nearby nerves, potentially causing symptoms over time.

Is it possible for a ganglion cyst to rupture?

In rare cases, a ganglion cyst can rupture following trauma, causing pain and swelling in the affected area. While this may temporarily alleviate the visible lump, it does not address the root cause, and medical attention may still be needed.

Can ganglion cysts recur in the same spot after surgery?

Although uncommon, ganglion cysts can recur in the same location after surgery. This usually occurs when small sections of the cyst wall or stalk were not completely removed during the procedure.

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Dr Jacqueline Tan

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

  • Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
  • Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
  • Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
  • Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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    Mt Elizabeth Novena Hospital

    38 Irrawaddy Road #07-42
    Singapore 329563

    Weekdays: 8:30am – 5:30pm
    Saturdays: 8:30am – 12:30pm
    Sundays & Public Holidays: Closed

    +65 9230 9554