GANGLION


Ganglion is the most common benign clinical entity that concerns the area of the wrist, its spine or palmar surface.
Ganglion contains a transparent gel, which comes either from the bones of the wrist or from the handles of the tendons of the hand.
The size of the ganglion may change over time and the activity of the individual (manual labor).
It may also appear in other parts of the knee such as the fingers of the hand, the foot and the knee.

 

ETIOLOGY

The cause of the disease has not been fully elucidated to date. It occurs more often in people who have manual activity but can also appear
in people who do not particularly strain their upper limb. In patients suffering from autoimmune diseases (rheumatoid arthritis, gouty arthritis, etc.), the incidence of ganglion is higher compared other people.

CLINICAL EVALUATION

Three are mainly the concerns of a person suffering from ganglion.
  •      If ganglion can be associated with malignancy
  •      The pain and perhaps the tingling in the wrist and hand
  •      The aesthetic factor especially in women if ganglion has large dimensions
Ganglion is not necessarily a painful condition. Can palpation and pressure cause pain in the area but this is particularly the case if the ganglion is in anatomical
affinity with nerve.


Large ganglion in the dorsal surface of the wrist at a female 37 years old. Ganglion, apart from the pain it causes to the patient, is also an aesthetic problem.

 

CONSERVATIVE TREATMENT
THERAPY: 

Conservative treatment typically involves resting the hand and avoiding weight gain over a 20-40 day period. This may reduce the size of the ganglion.
Applying a splint can help to reduce the size of the ganglion because it effectively reduces the activity of the wrist, but without it actually being able to heal the problem.

Sucking the ganglion gel with a needle can limit the size of the ganglion but recurrence to the initial levels is rapid, so it is not an official therapeutic proposition.

OPERATIVE TREATMENT
THERAPY: 

Surgical treatment with microsurgical techniques is the essential therapeutic approach to solving the problem.

1st CASE REPORT


Large ganglion at the dorsal surface of the wrist to a young woman.


Microsurgical preparation of the large ganglion which comes in close contact with a branch of the radial nerve, which causes numbness and pain in the wrist and hand. The ganglion is separated from the nerve and removed en block. In the photo the surgical forceps hold the nerve stem and underneath it the oversized ganglion clearly appears.


The ganglion has been removed. The nerve is kept intact.

2nd CASE REPORT


Ganglion on the palmar surgace of the wrist. The anatomical particularity of the area is that the radial artery (which is one of the two basic arteries of the hand) is located below and adjacent to the ganglion.

Microsurgical preparation of the ganglion


Removing the ganglion after its content has been removed


Ganglion

Microsurgery is performed with general anesthesia or upper limb anesthesia that hosts ganglion. The duration of surgery does not exceed 30-40 minutes and the patient returns to his home the same day without requiring hospitalization in the clinic. We avoid local anesthesia because in case of insufficient ganglion removal, the rates of recurrence are high.

Postoperatively there should be a period of rest of the hand for about 20 days. Heavy laborers may take 30 days.

Today, the improvement of surgical techniques - microsurgery and the use of surgical loops during operation, addressing this common clinical problem is definitive