Ganglion Excision

Ganglion Excision, ganglion cyst on the palmar side of the wrist
Ganglion cyst on the palmar side of the wrist. Image by Romina24, Wikimedia Commons, CC BY-SA 3.0.

Indications

  • Symptomatic wrist ganglion persisting after observation
  • Many resolve without treatment. Aspiration has high recurrence
  • Ganglions are the most common soft tissue mass of the hand and wrist
  • Occult dorsal ganglion causing wrist pain, confirmed with ultrasound or MRI

Position

  • Supine, arm table, tourniquet

Operative Steps

  1. Dorsal ganglion arises from the scapholunate ligament. Volar ganglion from the radioscaphoid or STT joints
  2. Transverse incision over the ganglion
  3. Dorsal, retract extensor tendons and trace the stalk to the joint
  4. Volar, protect the radial artery, which is often adherent
  5. Excise the stalk with a cuff of capsule without damaging the scapholunate ligament
  6. Arthroscopic excision is an option for dorsal ganglia
  7. Seed ganglion of the flexor sheath excised with a small window of sheath
  8. Mucous cyst of the DIP joint excised with the underlying osteophyte
  9. Close the capsule loosely and skin with fine sutures

Postoperative Care

  • Early motion
  • Light dressing or splint for comfort for about 1 week
  • Hand therapy for stiffness
  • Sutures out at 10 to 14 days

Complications

  • Recurrence
  • Radial artery and superficial radial nerve injury
  • Stiffness and scar
  • Recurrence after surgery is about 5 to 15%, lower than after aspiration
  • Scapholunate instability if the ligament is damaged
  • Neuroma of the posterior interosseous or palmar cutaneous nerves

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.