NHS Ganglion Excision | Deeping Surgical

What is a Ganglion Cyst?

A ganglion cyst is a fluid-filled swelling that develops near joints or tendons, most commonly on the wrist or hand. It is benign (non-cancerous), but can be uncomfortable, restrict movement, or affect function.

Symptoms may include:

A visible lump near a joint

Pain or a tingling sensation, especially with movement or pressure

Weakness or reduced mobility in the affected joint

When Should I Seek Treatment?

You should consider treatment if:

The cyst is painful or restricts movement

It is growing or changing shape

It affects your grip or fine hand control

It has not responded to aspiration or conservative treatment

What is the NHS Criteria for this procedure?

Ganglion Excision *For this procedure you should complete a prior approvals request, and once this is granted you should use the acceptance letter and send it with the referral for surgery*

Referral may be made where conservative treatment has failed, e.g., aspiration and there is pain or tingling/numbness or concerns (is cancer). Th patient must be 16 years of age or older and the ganglion must be <5cm.

The ICB will only fund surgical excision where the following EBI recommendations have been undertaken:

Wrist/volar/foot/knee ganglia

No treatment unless causing pain or tingling/numbness or concern (ie. malignant)
Aspiration if causing pain, tingling/numbness, or concern. (This is not covered under the Community Surgical Scheme).
Surgical excision only considered if aspiration fails to resolve the pain or tingling/numbness and there is restricted hand function

Seed ganglia that are painful

Puncture/aspirate the ganglion using a hypodermic needle
Surgical excision only considered if ganglion persists or recurs after
puncture/aspiration

Mucous cysts

No surgery considered unless recurrent spontaneous discharge of fluid or significant nail deformity.

Can It Be Treated Without Surgery?

Yes. Non-surgical options include:

Observation: Some ganglions go away on their own.

Pain Relief: Over-the-counter pain relief or a warm compress.

Aspiration: A doctor can remove the fluid with a needle. However, ganglions often return after aspiration.

What is Ganglion Excision Surgery?

Ganglion excision is a minor surgical procedure, done under local anaesthetic, to fully remove the cyst from the joint or tendon sheath to reduce recurrence risk.

What to Expect Before and After Surgery

Before Surgery:

You will have a consultation with the Surgeon immediately prior to the procedure to discuss risks and benefits.

You can eat and drink as normal on the day of the procedure.

If you take any blood thinning medication, it is important that you advise the Admin team prior to your appointment.

Please remove rings and jewellery from the hand having the procedure. Furthermore, due to the risk of infection, please remove nail polish from both hands.

After Surgery:

The wound will be dressed and you will be given instructions on wound care.
Mild pain, swelling and stiffness are common but should improve over time. Over-the counter painkillers such as paracetamol and ibuprofen are recommended for 24-48 hours.

Most patients return to normal activities within 1-2 weeks.

What Are the Risks?

Infection

Recurrence (can still happen in ~10–20% of cases)

Stiffness or scar sensitivity

Injury to nearby nerves or tendons (rare)

How Do I Prepare?

Medications: Inform your doctor about all medications and supplements you're taking.

Transportation: Arrange for someone to drive you home post-surgery.
Home Preparation: Set up a comfortable recovery area with necessary supplies within easy reach.

Patients Asking a doctor Questions _edit

Frequently Asked Questions

Q: How long does the procedure take?

A: The procedure will taking typically 30 minutes

Q: Will the ganglion come back?
A: Surgery reduces the risk, but there is still a small chance of recurrence.

Q: Is the lump dangerous?

A: No, ganglions are benign.

Q: How soon can I return to normal activities?

A: The joint (where the ganglion was) can continue to ache for a short time but joint stiffness should improve fairly quickly. You can drive as soon as you feel safe to do so. Most patients can return to normal activities within 4-6 weeks.