Ganglion excision

For the treatment of

Ganglia

Commissioning position

This intervention is commissioned if the ganglion:  

Causes symptoms that disrupt daily activities OR
Causes recurrent discharge or infection, when sited below the nail base

AND

Persists or recurs after aspiration/puncture.

Summary of rationale

A ganglion is a harmless fluid-filled lump under the skin that is usually near a joint. They commonly occur on the wrist, hand, ankle or feet. Rarely, the size and position of a ganglion can create symptoms by putting pressure on a nearby nerve. A form known as a seed ganglion can occur attached to the flexor tendon at the base of a finger on the same side as the palm. A ganglion below the base of a nail can deform the nail bed and occasionally cause intermittent discharge of mucous fluid or become infected. All ganglia can disappear without treatment.  

If a ganglion does not cause pain, tingling or numbness that disrupt normal activities (or recurrent discharge or infection in the case of those below the base of a nail), then it can be left alone and may resolve with no treatment, which can take several years. 

Aspiration (or puncture in the case of small seed ganglia) using a hypodermic needle should be performed first for ganglia causing more than mild symptoms. 

Excision can be considered if aspiration/puncture fails to relieve symptoms or there is recurrent discharge or infection in the case of those below the base of a nail. 