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Ganglion

Checked: 18-03-2025 by Rob Adams Next Review: 18-03-2027

Overview

A ganglion is a fluid-filled lump which can occur near joints or tendons. It is most commonly found on the wrist or hands. It is usually harmless and often, no treatment is needed. If required and criteria are met (1) , a ganglion can be injected, aspirated or removed surgically.

A ganglion is a swelling that contains a thick jelly-like material and is usually attached to a joint or tendon . The fluid inside is a thicker version of the synovial fluid. It looks and feels like a smooth lump under the skin. It is not fully understood how it occurs. In some cases they occur after an injury but in most there is no obvious cause.

The most common site for a ganglion to be found is on the back of the wrist. It can also occur on the other side of the wrist, on the hand, and on the top of the foot. Other sites of the body are affected less commonly (2).

Who to Refer

In most cases a ganglion can be diagnosed clinically and reassurance given (3). Referral or imaging are not usually required.

Wrist and Hand Ganglia

Surgery for patients with wrist and hand ganglions is only funded in exceptional circumstances.

Foot and Ankle Ganglia

In some cases a referral to MSKI services can be made to consider a guided injection or aspiration or for surgical excision. Referrals should be considered if the criteria laid in the Ganglion Referral and Removal - BNSSG ICB prior approval policy have been met.

Surgery for ganglia at all other sites are subject to exceptional funding.

Red Flags

If a lump is suspicious and there are concerns about malignancy please consider using the Bone & Soft Tissue - USC (2WW) referral pathway.

What to do before referral

When referring to MSKI services please state clearly in a referral how criteria are met (as above).

Please also consider the following prior to referral:

Photos

If possible, please include photos of the ganglion with a referral (although this is not mandatory)

Imaging

Most ganglia can be diagnosed clinically and imaging it not routinely required. Consider imaging (USS or MRI) if there is diagnostic uncertainty or if there is significant neurovascular compromise. Imaging can be considered and requested on ICE but please include clinical details and indication for imaging as otherwise requests may be returned.

Prior Approval

Applications for Prior Approval for surgical management are not required when referring from primary care. These applications will be made following review by the MSK team if the criteria are met.

Advice and Guidance

If you are unsure about the appropriateness of a referral or need further advice then please consider using the MSK Advice & Guidance Service.

Referral

Patients who meet criteria for referral should be referred via the community Musculoskeletal (MSK) Interface Service.

Musculoskeletal Interface (MSKI) Service

Direct referrals for surgery from primary care (i.e. to plastics or hand surgeons, etc) should not be made and will be returned.

Patients who are seen by the MSK team will be reviewed and treated as appropriate if funding criteria are met (1). Please manage patient expectation, as not all patients will meet criteria for surgical management and may be discharged without any further treatment.

Resources

(1) Ganglion Referral and Removal - NHS BNSSG ICB

(2) Ganglion (Causes, Symptoms, and Treatment) (patient.info)

(3) Ganglion cyst - NHS (www.nhs.uk)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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