Ganglion- Adult Leeds

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1.  Information Resources for Patients and Carers

Quick info:

Patient information

Please see attached patient information leaflet on Basal Thumb Osteoarthritis.

Please see attached patient information leaflet on Dupuytren's disease.

Please see attached patient information leaflet on Trigger Finger.

Please see the attached patient information leaflet on De Quervain's Tenosynovitis.

Please see attached patient information leaflet on  ganglion cysts.

Please see the attached patient information leaflet on Carpal Tunnel Syndrome.

Decision Aid for Carpel Tunnel

Preoperative Information

Please see attached patient information leaflet for preoperative information on Basal Thumb Osteoarthritis.

Please see attached patient information leaflet for preoperative information on Dupuytren's disease.

Please see attached patient information leaflet for preoperative information on Trigger Finger.

Please see the attached patient information leaflet for preoperative information on De Quervain's Tenosynovitis.

Please see attached patient information leaflet for preoperative information on ganglion cysts.

Please see attached patient information leaflet for preoperative information on Carpal Tunnel Syndrome.

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2.  Referral Forms

Quick info:
Referral Forms

Mail Merged
The forms below are provided as a repository. They can be downloaded to your computer and be imported to your clinical system. This is so all practices have access to the most up to date forms.

EMIS - merged
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

SystmOne - merged
MSK12 Non Surgical Hand-Wrist Form V3
MSK13 Surgical Hand-Wrist V3
MSK14 Problem Not on Pathway Form V3

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3.  Ganglion

Quick info:
Patient information
Please see attached patient information leaflet on ganglion cysts.

GP information
Ganglion:

  • is a common benign smooth round swelling of the hand and wrist
  • can vary in consistency from soft to bony hard according to the pressure inside it
  • are seldom attached to skin, though they can be single or multi-loculated
  • arise when synovial fluid leaks from a joint or tendon tunnel
  • most can be confidently diagnosed without imaging because they arise in typical locations with typical features. If doubt on diagnosis exists, follow the 'Uncertain diagnosis' pathway

Management:

  • there is no requirement for treatment unless the ganglion is symptomatic   symptoms may include local pain, discomfort from nerve branch entrapment, and reduced range of movement of a part or joint
  • about 40% resolve spontaneously
  • most ganglions will have no clear cause; however, if treatment is felt to be necessary, and the ganglion is likely secondary to a condition such as osteoarthritis or rheumatoid arthritis, the patient should be managed according to the underlying condition
  • if there is no underlying condition, the ganglion should be managed according to its location

Four types of ganglion exist:

  • Dorsal Ganglion:
    • typically occurring in young adults
    • presents as a swelling on the dorsal aspect of the wrist
    • may resolve spontaneously
    • if required, and if local expertise exists in the practice, it is reasonable to consider aspiration on up to 2 separate occasions. If this proves unsuccessful, it is reasonable to refer to a Hand Surgeon.
  • Volar (Palmar) Wrist Ganglion:
    • typically occurring in young adults
    • presents as a swelling on the volar aspect of the wrist (and in older adults possibly in association with arthritis)
    • aspiration may damage local structures so if symptomatic and the patient wishes to consider treatment, referral to a Hand Surgeon is appropriate.
  • Flexor Sheath Ganglion:
    • typically occurring in young adults
    • presents as a swelling at the base of the finger, arising from the flexor tendon
    • can cause irritation and pain when gripping. If treatment is required, referral to a Hand Surgeon is appropriate.
  • Mucoid Cyst Ganglion (Dorsal digital ganglion):
    • typically occurring in older adults
    • presents as a swelling at the distal inter-phalangeal joint of the finger, often due to underlying degenerative change
    • aspiration may cause joint infection, and should be avoided. It is likely no treatment will be required, but if felt necessary, referral to a Hand Surgeon is appropriate.

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4.  Uncertain Diagnosis

Quick info:
GP information
Many ganglions can be confidently diagnosed without the need for imaging. If doubt exists however, it is appropriate to refer for ultrasound scan to confirm the diagnosis. This is important to exclude rare soft tissue malignancies.

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11. No - is there a reason to consider surgery?

Quick info:
GP information
Around 40% of ganglions resolve spontaneously, and for many there is no need to offer any treatment. Reassurance is often all that is required.

For a relatively small number of ganglions, surgery may be considered if:

  • the ganglion is the likely cause of persistent wrist pain, either through local effects or likely pressure on a nerve
  • the ganglion is the cause of reduced wrist function, perhaps through loss of range of movement or pain
  • there is persistent patient concern regarding the nature of the lesion

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15. Mucoid Cyst Ganglion - Refer to Hand Surgeon, if Surgery Acceptable

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GP information

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16. Volar Wrist Ganglion - Refer to Hand Surgeon, if Surgery Acceptable

Quick info:
GP information

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17. Flexor Sheath Ganglion - Refer to Hand Surgeon, if Surgery Acceptable

Quick info:
GP information

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18. Dorsal Ganglion

Quick info:
GP information

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21. Surgery Acceptable - Refer Hand Surgeon Referral Form (MSK13)

Quick info:
Referral Form:
MSK13 Surgical Hand-Wrist V3

Choose & Book
All providers except LTHT appear under;

Speciality: Orthopaedics
Clinic type:Hand & Wrist

LTHT appears under;

Speciality:Surgery - Plastics
Clinic:Upper Limb
Service:Adult Upper Limb - Surgery Plastics

Patient information
Please see attached patient information leaflet  on ganglion cysts.

Provider information
Common providers of this procedure to Leeds patients include:

  • LTHT
  • Spire   please note, exclusions apply
  • Yorkshire Clinic   please note, exclusions apply
  • BRI
  • Harrogate
  • Mid Yorks
  • Calderdale Royal Infirmary
  • Eccleshill   please note, exclusions apply

Where exclusions apply common exclusions include:

  • anaesthetic risk
  • previous anaesthetic complication
  • significant co-morbidity
  • severe psychiatric morbidity

Please see Choose & Book Directory of service for additional information.

Key Dates
Published: 16-Dec-2015, by Leeds
Valid until: 19-Feb-2016

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