Surgical treatment may be needed for a ganglion that has not responded to nonsurgical treatment and:

• Is painful.
• Interferes with activity or motion.
• Causes changes in sensation.
• Becomes unsightly.
• Is causing damage to wrist bones, finger bones, or ligaments.

The goal of surgery is to remove the ganglion sac and the connecting tissue that allows the fluid to collect.

Surgical removal of a ganglion is an outpatient procedure.

• The area around the ganglion is cleaned with an antiseptic.
• A local anaesthetic is injected to numb the area or a regional anaesthetic is injected to numb the whole arm and hand. (General anaesthetic is not usually used because the surgery does not take long and affects only the wrist or hand.)
• A cuff (tourniquet), similar to the kind used for taking blood pressure, is placed on the upper arm. This is inflated before the procedure to decrease the blood flow to the hand and wrist.
• An incision is made at the ganglion site. The surgeon is careful to protect nerves,tendons, ligaments, and blood vessels while removing the ganglion sac and the connecting tissue.
• The incision is closed with stitches, and a bandage and (in some cases) a splint are applied to restrict movement and allow the incision to heal. Some surgeons encourage moving your wrist 3 to 5 days after surgery to prevent stiffness.

Infection and injury to other tissues are rare, but possible, risks of surgery.

Ganglions return in about 5% to 10% of people after surgery. This may happen if the connecting tissue is not completely removed. New ganglions may also form in the area.

In a mucous cyst ganglion, bone spurs (small, bony growths that form along a joint) are often present in the joint next to the cyst, and removing bone spurs makes it less likely that the cyst will return. The chance of infection is higher in mucous cysts.