Reviewed on : 22 Oct 2025

Reviewed by : Lucy Dyde, IFR Team Manager

Expires : 22 Oct 2027

Ganglia Hand and Wrist

Prior approval from the ICB will be required before any treatment proceeds in secondary care

Ganglia are cystic swellings containing jelly-like fluid which form around the wrists or in the hand

In most cases wrist ganglia cause only mild symptoms which do not restrict function, and many resolve without treatment within a year

Wrist ganglion rarely press on a nerve or other structure, causing pain and reduced hand function

Ganglia in the palm of the hand (seed ganglia) can cause pain when carrying objects

Ganglia which form just below the nail (mucous cysts) can deform the nail bed and discharge fluid, but occasionally become infected and can result in septic arthritis of the distal finger joint

Rationale for recommendation

Most wrist ganglia get better on their own

Surgery causes restricted wrist and hand function for 4-6 weeks, may leave an unsightly scar and be complicated by recurrent ganglion formation

Aspiration of wrist ganglia may relieve pain and restore hand function, and “cure” a minority (30%)

Most ganglia reform after aspiration but they may then be painless

Aspiration also reassures the patient that the swelling is not a cancer but a benign cyst full of jelly

Complication and recurrence are rare after aspiration and surgery for seed ganglia

The most common post-operative complications requiring readmission to hospital include bleeding, infection, pain and vomiting

In the GIRFT report, the readmission rate for:

• Haemorrhage was found to be 8% (13% for adults and 5.7% for children) of with 1.3% returned to theatre (2.3% adult and 0.8% children)
• Infection 1.1% (1.4% for adults and 1.0% for children)
• Pain 0.5% (0.8% for adults and 0.4% for children)
• Nausea and vomiting 0.1% (0% for adults and 0.2% for children).

Eligibility Criteria

Wrist ganglia:

• No treatment unless causing pain or tingling/numbness or concern (worried it is a cancer)
• Aspiration if causing pain or tingling/numbness
• 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

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB

Guidance/References

https://ebi.aomrc.org.uk/interventions/ganglion-excision/

Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: Systematic review and meta-analysis. J Hand Surg Am. 2015, 40: 546-53

Naam NH, Carr SB, Massoud AH. Intraneural Ganglions of the Hand and J Hand Surg Am. 2015 Aug;40(8):1625-30. doi: 10.1016/j.jhsa.2015.05.025. PubMed PMID: 26213199.

BSSH (2016) Ganglion cysts https://www.bssh.ac.uk/patients/conditions/20/ganglion_cysts