Flexor Tendon Sheath Ganglion Excision Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. We recommend this procedure when non-operative care has not given enough improvement. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For long-standing problems, we usually try activity change, hand therapy, splinting, and injections first. Surgery follows when those have not helped enough.
This operation removes a fluid-filled cyst from the tendon sheath. It is offered to patients with persistent pain or stiffness that limits daily tasks. The main benefit is restoring comfortable movement and function. While some cysts shrink on their own, surgical removal offers a significantly lower chance of recurrence compared with aspiration. Surgical intervention for wrist ganglions has about a 10% recurrence rate. We aim to provide lasting relief so you can return to your normal activities with greater stability and less pain.
Before the operation
If you have other medical conditions, you may need blood tests or a review with the anaesthetist before surgery. Please fast for the time specified by your anaesthetist. We advise stopping certain blood-thinning medications only after your surgeon gives you specific instructions. Arrange for someone to drive you home, as you cannot drive yourself after the procedure. Bring a complete list of all current medications and supplements. Wear comfortable, loose-fitting clothing to make getting dressed easier after your procedure. This preparation helps us keep your surgery smooth and safe.
On the day
You present to the hospital’s surgical admissions unit. You are checked in and prepared for theatre. You meet the anaesthetist to discuss your care. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.
You are then taken into the operating theatre, where the operation is performed. You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable you either go to the ward or go home, depending on the procedure and your recovery. Your surgeon ensures you are comfortable and ready for the next step in your care.
What the operation involves
Your surgeon performs this procedure using an open approach. This means a single conventional cut is made directly over the area where the ganglion cyst is located on your flexor tendon sheath. This allows direct access to the cyst and the surrounding tissues.
Once the skin is opened, your surgeon carefully identifies the ganglion cyst. The cyst is a fluid-filled sac that often connects to the joint or tendon sheath. Your surgeon removes the entire cyst wall to ensure it does not return. If the cyst communicates with a joint, your surgeon may also address any underlying irritation within that joint space to help prevent future fluid buildup.
After the cyst is removed, your surgeon checks the surrounding tendons and nerves to ensure they are healthy and moving freely. The cut is then closed with stitches. A sterile dressing is applied to protect the area while it begins to heal. This direct method allows your surgeon to see exactly what they are doing, ensuring the cyst is fully removed while protecting the important structures nearby.
After the operation
You will wake up in the recovery ward with your hand in a dressing and possibly a splint. Your surgeon will manage your pain to keep you comfortable. This is usually a day case, so you can expect to go home the same day, although occasionally patients stay overnight. Please ensure someone stays with you for the first 24 hours to help you rest. Keep the dressing clean and dry while it heals. You can usually return to driving within one to two weeks, once the wound is comfortable and you can grip and turn the wheel without protecting the operated hand. If a splint is used, NO DRIVING until it is off. Learn more at Driving after upper-limb surgery.
Recovery
You can expect some swelling and soreness in the first few days. This is normal as your body heals. We keep discomfort manageable with simple pain relief. Most people find the pain settles significantly within a few weeks. You will notice less swelling as you move your hand gently.
We use a splint to protect the area while it heals. You must keep this splint on at all times until we remove it. Do not drive while wearing the splint. You can usually return to driving once the splint is off and you can grip the wheel comfortably. This typically happens within one to two weeks, but your surgeon will confirm when it is safe for you to drive.
Once the wound is comfortable, we start gentle movement. You will work with Ruby Doolan at Extend Rehabilitation to guide your hand therapy. These exercises help restore strength and flexibility. You will gradually return to daily tasks like typing or cooking as your grip improves. Your timeline may differ; your surgeon and hand therapist will guide you based on how you heal.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
The most common issue is the ganglion returning. You might notice a lump coming back at the same spot. It may feel like a small, soft balloon under the skin. If you see this, let your surgeon know at your next check-up. They will decide if further treatment is needed.
Sometimes, the wound itself can cause trouble. You might see redness spreading out from the cut. The area could feel warm or tender to the touch. In rare cases, you might notice clear fluid or pus leaking out. If you see these signs, call the clinic right away. Do not try to clean it deeply yourself.
Nerve irritation is another possible risk. You might feel tingling, numbness, or a sharp electric shock sensation in your hand or fingers. This can happen if the nerves near the ganglion are irritated during surgery. If you notice new weakness in your hand or fingers, tell your surgeon immediately. Most of these sensations fade over time, but they need checking.
Infection is a small risk with any surgery. You might feel generally unwell with a fever. The pain at the surgical site might get worse instead of better after the first few days. If you have a high temperature or severe pain that simple painkillers do not help, go to the emergency department or call your surgeon.
Scar tissue can sometimes form inside the wound. You might feel a hard knot under the skin that moves when you press it. This is usually harmless but can be uncomfortable. If it bothers you or limits your movement, mention it at your follow-up visit.
The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you have a fever, increasing redness, or discharge from the wound. Seek emergency care for sudden severe pain, calf swelling, or shortness of breath. Contact us immediately if you lose sensation or cannot move your hand. These signs need urgent assessment. We are here to help you recover safely and comfortably.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Flexor Tendon Sheath Ganglion page.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Flexor Tendon Sheath Ganglion page.
