The word “ganglion” means “knot” and is in this case used to indicate the knot-like mass that forms below the surface of the skin.
A cyst is a sac of fluid. Ganglion cysts are filled with a thick, sticky, clear, colorless, jellylike material. Their size may vary and it influences if the cysts will feel firm or spongy.
A ganglion cyst may occur as one large cyst or many smaller ones. Multiple smaller cysts can often give the appearance of more than one cyst, but a common stalk within the deeper tissue usually connects them.
Ganglion cysts may even be so small that they are invisible. Often the only indication of the smaller, hidden ganglion cysts is pain.
Ganglion cysts occur around joints and tendons in the hand or foot. Most commonly, the cysts appear on the back of the hand (60-70%), at the wrist joint but can also develop on the palm side of the wrist. Other less common sites include joints on the shoulder, elbow, outside of the knee and ankle, hip, the top of the foot and the fingertip, just below the cuticle.
A ganglion grows out of a joint and looks like a balloon on a stalk. It rises out of the connective tissues between bones and muscles. Inside this balloon is the already mentioned thick, slippery fluid similar to the synovial fluid in our joints.
This type of cyst is not harmful.
The only symptoms are its appearance and occasionally pain. The pain may occur if the fluid-filled sac puts pressure on the nerves that pass through the joint. Smaller ganglions, hidden under the skin, may be quite painful while the big ones are unattractive but this is not the rule.
The more active the wrist is, the larger the cyst becomes but with rest, the lump generally decreases in size.
Ganglion cysts are more 3 time more likely to occur in women than in men but can actually develop in patients of any age and sex, even children. Seventy percent of ganglion cysts occur in patients between the 20 and 40 years of age and around 15% of ganglion cysts occur in patients younger than 21 years.
The exact cause of the formation of ganglion cysts is still unknown. It is known though that the cysts form when tissues surrounding certain joints become inflamed and swell up with lubricating fluid, so a trauma to the joint or tendon could be a trigger. Overuse of a specific joint, which results in the degeneration of the surrounding fibrous tissue, is also regarded as a risk factor. Other risk factors include regular, repetitive movement that stresses your wrist or hand like in weight lifters, gymnasts, waiters, tennis and golf players; having osteoarthritis, which can increase fluid within the joints and make it leak into the tendon sheath and accumulate in an existing cyst; or it may be an early signs of arthritis that will become more obvious in the future. Rheumatoid arthritis is also associated with ganglion cysts.
Sometimes, ganglion cysts may disappear by themselves, however, most of the time, they linger around or grow larger. When large enough, they start putting pressure on surrounding structures and this is when the pain begins. Pain is the most common reason the ganglion cysts are removed.
Home care used to include applying heat, topical plaster or even smashing the cysts with heavy objects such as large books but these measures are no longer suggested simply because they did not prevent the cysts from reoccurring and could actually cause further injury.
Other conditions can cause lumps around the wrist, so it is important to have this type of lump checked by a doctor. Other conditions include a lipoma or giant cell tumor, infections and carpal bossing (bone spur) and they have different treatments.
A doctor will perform a physical exam but may even order X-rays to rule out other conditions, such as arthritis or a bone tumor or MRI and ultrasound if a ganglion cyst is not visible.
The initial treatment is not surgical.
Your doctor will first decide to
• OBSERVE the ganglion cyst. Watching for some time is encouraged because ganglion cysts are not cancerous and may even disappear in time.
The doctor may even suggest
• Shoe modifications if the cyst occurred on a foot. Doctors usually advise wearing shoes that do not rub the cyst or cause irritation as well as placing a pad inside the shoe to reduce pressure against the cyst.
• Immobilization because activity tends to make the ganglion to increase in size and cause pain by increasing pressure on nerves. A wrist brace or a splint may relieve symptoms and help the cyst decrease in size. Exercises may also be encouraged to strengthen the wrist and improve range of motion.
Actual treatment may include:
Aspiration is a procedure in which the fluid gets drained from it by punctured with a needle and drainage. However, ganglion cysts may return after aspiration. The recurrence rate may be as high as 80 percent. If this happens, aspiration can be repeated and multiple aspirations may result in no recurrence of the cyst.
Some doctors recommend a steroid injection into the empty cyst after aspiration to reduce the recurrence rate of the cyst. If this combination fails, and the cysts reoccurs, a surgery may be suggested to have it removed.
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Surgery is, in most cases, performed on an outpatient basis, and you will be able to go home the same day. You will undergo local or general anesthesia. The surgery is done by making an incision in your skin at the location of the ganglion cyst. The size of the incision depends on the size of the cyst. The surgeon will remove the cyst, then suture and bandage the affected area. During the surgery, your doctor may also remove part of the involved joint capsule or tendon sheath.
Some tenderness, discomfort, and swelling may be felt after the surgery but normal activities are usually resumed two to six weeks after the surgery.
Your doctor or his staff may advise you to keep the area elevated for up to 48 hours to help reduce swelling and recommend analgesics, such as acetaminophen (Tylenol, others), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Naprosyn, others) to relieve discomfort.
Surgery is no guarantee that a ganglion cyst won't recur. The recurrence rate is reduced to only 5 to 10% though if the cyst is fully taken out. Complications rarely develop.
An alternative to open excision of ganglion cysts that is available today is arthroscopy. During arthroscopy, the origin of the cyst can be seen. This procedure requires no immobilization after.