LLR Policy for Ganglion- Hand or Wrist   

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Threshold Criteria

A ganglion is a benign, fluid-filled cyst that forms around joints or tendons. Ganglions can occur alongside any joint, but are most common around the wrist, hands and fingers. Ganglions are harmless and most are symptom free, but they vary in size and can occasionally give pain, weakness, restriction of mobility or pressure neuropathy. Untreated, approximately 50% resolve spontaneously. Recurrence rates after surgery can be up to around 40%. Complications of surgical excision include scar tenderness, joint stiffness and distal numbness.

Surgical excision will not be commissioned for cosmetic reasons


LLR  ICB will only fund this procedure when the following criteria is met
·         Significant functional impairment (significant restriction of work/domestic/care duties); significant pain; neurological deficit; weakness of the joint; inhibition of nail growth.
·         Awareness of frequency of spontaneous resolution, likelihood of recurrence and possible complications of excision.
Clinical PresentationDorsal or Palmar wrist swellingDorsal or Palmar wrist swelling with severe pain or diagnostic uncertainty
ManagementObserve Consider aspiration for diagnostic purposesRefer for surgical assessment


ARP 46. Review Date: 2026

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