Surgery for ganglion cyst

This is a summary of the NHS Devon CCG commissioning policy for surgery for ganglion cyst.

Supporting referral guidelines


Signs and Symptoms

A ganglion cyst arises when the synovial fluid leaks out of a joint or tendon tunnel and forms a swelling beneath the skin. The cause of the leak is generally unknown. Ganglion cysts occur most frequently on the hand or wrist. Ganglion cysts may also occur on the knee, ankle or foot but these cases are comparatively rare.

Long-term follow-up studies of patients with untreated ganglia of the wrist report that approximately 40% of ganglia resolve spontaneously. Surgery may initially be successful in a high proportion of patients, however, recurrence rates of up to 20% have been reported depending on the location of the ganglion and duration of follow-up. Two studies suggest there is little difference in symptoms in the long term between patients who underwent surgery and patients whose ganglion was left untreated. Complication rates vary according to the type of surgery and are reported to range from 5% to 10% of procedures.

Limited information is available for the outcome of surgery in patients with ganglion cysts of the lower limbs. Lower recurrence rates were reported during long-term follow-up of patients with ganglion cysts of the lower limb compared with the figures reported for ganglia of the wrist but there are fewer studies of lower limb ganglion cyst and these studies have small numbers of patients.


Referral Criteria

Surgery for removal of a ganglion cyst will be routinely commissioned only in the following circumstances:

  • Ganglion of the upper or lower limb causing significant pain or significant functional impairment*
  • Mucoid (myxoid) cysts at distal interphalangeal joint (DIP) which is causing significant functional impairment* or pain, or there are cysts that discharge

*Significant functional impairment is defined as a loss or absence of an individual's capacity to meet personal, social or occupational demands.

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Exceptional /Individual Funding Requests (IFR).

NHS Devon CCG commissioning policy: Surgery for ganglion cyst

Referral Forms

Ganglion Cyst Interventions Referral Proforma EMIS web

Ganglion Cyst Interventions Referral Proforma Microtest

Ganglion Cyst Interventions Referral Proforma No Merge Fields

Ganglion Cyst Interventions Referral Proforma Systmone

Supporting Information

Patient Information

Individual Funding Request (IFR)

Publication date: 23 December 2016


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