Surgery of a ganglion is a surgical-therapeutic procedure to remove a ganglion (overbone). A ganglion describes a singular (single) or multiple structure that is a neoplasia (new formation) of tissue. This neoplasia is a benign (non-spreading and limited growth) process that can occur either in the joint capsule area or on a superficial tendon sheath. Although ganglion is used synonymously with the term ganglion, the two terms describe principally different pathological processes. In contrast to the ganglion, a “true” ganglion has a pathological ossification, which is correctly called an exostosis. Furthermore, as a cystic neoplasm, a ganglion is filled with fluid that is both filamentous and clear. In addition to possible mechanical interference with surrounding joint structures, a ganglion is often accompanied by localized tenderness. Hyperresponsiveness (hypersensitivity reaction) of the skin above the ganglion can also usually be detected. Surgical treatment of the ganglion
Before an invasive therapy measure is considered in the treatment of a ganglion, an individual review of a use of the conservative (non-surgical therapy measures) therapy methods should take place. As a rule, the use of cortisone is recommended initially after diagnostic confirmation of the findings. There is also the possibility of puncturing the ganglion to reduce the pain and mechanical restrictions. If, despite the conservative measures used, debilitating pain or movement restrictions continue to occur, surgery is considered unavoidable. However, during the procedure, the surgeon must be careful not to damage or remove nonpathologically altered tissues in addition to the ganglion. Meniscal ganglia, in particular, should be treated so that no secondary damage occurs to the affected meniscus.
Indications (areas of application)
- Ganglion with mechanical impairment – usually, direct surgical intervention should not be used for this finding. However, conservative measures are often unsuccessful, so the use of a surgical intervention is necessary.
- Ganglion with paresthesia – if paresthesia (paraesthesia) occurs in the presence of a ganglion, immediate surgery is indicated to prevent possible permanent damage or to minimize the risk of developing permanent damage. The paresthesia here represents a consequence of the space occupation of the ganglion, by which the nerve fibers are compressed and impaired their function.
- Ganglion with reduced blood supply – as a result of the occurrence of a ganglion, blood vessels can also be compressed, so that certain tissue areas are inferiorly supplied. Here, too, surgery is indicated, as consequential damage may occur.
- Ganglion with strong growth – if the ganglion increases significantly in size, surgical treatment should be considered to prevent possible damage from the growth.
Contraindications
A significantly reduced general condition often prevents the performance of ganglion removal, as anesthesia would be associated with too high a health risk. Attention should be paid to a possible allergic reaction during and after surgery.
Before surgery
Discontinuation of anticoagulants (anticoagulants) – discontinuation of medications that help to inhibit clotting (“thin the blood“) is usually necessary before surgery is performed. After surgery, medication can usually be resumed relatively quickly. Discontinuation of therapeutic measures during surgical care should be done only under a physician’s orders.
The surgical procedure
Both general and local (local) anesthesia are indicated for surgical removal of a ganglion. On the one hand, the choice of anesthesia option depends on the localization of the ganglion; on the other hand, the patient’s wishes also represent a decisive factor. In addition to anesthesia, blood flow arrest (suspension of blood supply in the surgical area) can be performed prior to the surgical procedure, so that the surgeon can be guaranteed a better view as a result of blood stasis.Furthermore, arresting the blood flow is also associated with a reduced likelihood of high patient blood loss. Depending on the procedure used, a microscope is used to remove the ganglion in order to better assess the ganglion structures. Due to the fact that a ganglion is primarily located in the joint capsule area or tendon area, stabilization of the surgical area after the procedure may be necessary. Plaster casts or stabilizing bandages may be used for this purpose.
After surgery
- Rest – immediately after the operation performed, the patient should rest the surgical area for a few days to ensure optimal wound healing.
- Movement – after the period of rest, however, should be an active movement of the joint to achieve full functionality of the joint. Supportive physiotherapy can contribute to recovery in this case.
Possible complications
- Bleeding and vessel rupture – as a result of the localization of the blood vessels, injury such as ruptures (tears) of the vessels can often occur, so postoperative bleeding can occur during and after surgery if hemostasis is inadequate.
- Hematomas – hematomas (bruises) are also the result of injury to blood vessels and the associated bleeding.
- Paresthesias – due to a lesion (damage) of the nerves in the surgical area, paresis (paralysis) and paresthesias (insensations) may occur. However, as a rule, the complaints are temporary (time-limited) events.
- Wound healing disorders – depending on the wound care and the predisposition to scarring, wound healing disorders may occur as a result of the procedure.
- Complex regional pain syndrome (CRPS); synonyms: Algoneurodystrophy, Sudeck’s disease, Sudeck’s dystrophy, Sudeck-Leriche syndrome, sympathetic reflex dystrophy (SRD)) – neurological-orthopedic clinical picture, which is based on an inflammatory reaction after injury to an extremity and in addition, the central pain processing is involved in the event; represents a symptomatology in which there are severe circulatory disturbances, edema (fluid retention) and functional restrictions after the intervention, as well as hypersensitivity to touch or pain stimuli; Occur in up to five percent of patients after distal radius fractures, but also after fractures or minor trauma to the lower extremity; early functional treatment (physical and occupational therapy), with medications for neuropathic pain (“nerve pain) and with topical (“local”) therapies lead to better long-term results.
