A ganglion is not simply a herniation of the small joints in the hand and wrist. These lumps may be sentinels for more serious problems such as inter-carpal (small bones of the palm) ligament degeneration. Pressure on adjacent structures such as nerves may occur. Ganglia are often painful and will require initial treatment with needle aspiration and injection as well as a compression orthosis. Needle aspiration can be considered if the ganglion is <1cm diameter and a single chamber. With larger ganglia and multi-loccular ganglia surgery is the preferred treatment method. Surgery is undertaken after excluding underlying pathology. In some younger patients with weight bearing on the wrist, pain and restriction of motion occurs that lasts for a few days or weeks. This may be due to an occult ganglion ( not visible ) associated with synovitis and is best diagnosed by doing an ultrasound of the wrist. Simply “hitting it with the family bible” is unfortunately not curative.
