What is a Ganglion Cyst?
A ganglion cyst is a type of soft tissue tumor most often found around the tendons and joints of the hand and wrist. The cyst consists of a round or oval membrane that is filled with fluid and attached to the underlying structure by a stalk, commonly compared to a balloon on a string. A ganglion cyst can be firm or soft. It can appear gradually or suddenly, changing in size over time and sometimes spontaneously disappearing, and can be found singly or in groups of cysts.
What Causes Ganglion Cysts?
No definitive cause of ganglion cysts has been established, but they have been associated with stressful repetitive motion and with wrist sprains, an etiology supported by the relatively high incidence of such cysts among gymnasts and by the tendency of some cysts to decrease in size with rest. They are more common in women than in men, but are found in people of all ages.
Although a ganglion is generally defined as a mass of cells, especially nerve cells, ganglion cysts are not composed of those cells. Instead, a ganglion cyst is filled with a thick fluid that resembles synovial fluid, the lubricating substance found between joints.
What are the Symptoms of a Ganglion Cyst?
A ganglion cyst most often appears as a painless lump on the wrist, but it can also develop in the palm or in the fingers themselves. When found at the joint of the finger closest to the nail, they are known as mucoid cysts, a condition associated with degenerative arthritis and frequently accompanied by an arthritic bone spur at the site.
Not all ganglion cysts are painless. Those that are not visible, the occult cysts, are more likely to cause pain because of their closer connection to functional structures beneath the surface. MRI imaging can be used to examine an occult cyst that is otherwise invisible. X-ray, although unable to provide an image of the cyst itself, can be deployed in order to examine underlying conditions like arthritis.
The surgical procedure is relatively simple and recovery is similarly straightforward. There may be tenderness around the area for up to six weeks, but pain can typically be managed with over-the-counter medication, the use of a splint or a combination of the two. The need for physical therapy is rare.
Regardless of the treatment, there is always the chance, however small, that a ganglion cyst will recur. In fact, non-surgical recurrence rates are reportedly as high as 80 percent. Surgery, while not a guaranty against recurrence, offers the best long-term results by far.
At one time, home treatment consisted of smashing the cyst with a large book, most likely the Bible, and ganglion cysts were popularly known as bible cysts. Fortunately, this ineffective and potentially dangerous practice has been replaced by several less dramatic and far more effective options. Treatment starts with rest and immobilization, sometimes assisted by the application of a prescription splint and by the use of non-steroidal anti-inflammatory drugs for pain relief.
Aspiration, in which the cyst is lanced and drained, is often the next option. Aspiration may be followed by a steroid injection at the site to lessen the chances of recurrence, but the majority of ganglion cysts will recur nonetheless.
Surgical treatment is far more effective than non-surgical options. In surgery, generally an outpatient procedure, the cyst, its stalk and, if necessary, a minimal amount of surrounding tissue are removed. The surgeon may supplement the procedure with wrist arthroscopy in order to minimize the surgery’s invasiveness and to better assess the condition of wrist cartilage and ligaments adjacent to the cyst.
With a rate of recurrence of approximately five percent, surgery markedly improves outcomes in comparison to non-surgical treatment. It also conveys another important ancillary benefit: Excision of the cyst allows laboratory analysis to rule out any possibility that the cyst is not benign.
Ganglion Cyst Videos
See Dr. Knight discuss his protocol for ganglion cysts. Click on video.
HandSurgeonOrangeCounty.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer.