LLR Policy for Ganglion- Hand or Wrist

September 11, 2023

Category

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

Eligibility

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.

AND

· Awareness of frequency of spontaneous resolution, likelihood of recurrence and possible complications of excision.

	Mild/Moderate	Severe
Clinical Presentation	Dorsal or Palmar wrist swelling	Dorsal or Palmar wrist swelling with severe pain or diagnostic uncertainty
Management	Observe Consider aspiration for diagnostic purposes	Refer for surgical assessment

Guidance

http://www.bssh.ac.uk/education/guidelines/ganglion.pdf