A Ganglion cyst is a very common non cancerous lump that occurs within the hand and wrist and adjacent to joints or tendons. Ganglion cysts are usually round or oval in shape and measure less than 2.5 cm in diameter.
The most common locations are the top of the wrist, the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger. Unusually can occur on the elbow, knee, foot, shoulder and toe.
These fluid filled cysts can quickly appear, disappear and change size. Grow larger with increased activity and with rest, the lump typically becomes smaller.
Presents as a lump on the dorsum of the wrist, palm, near the end joint of the fingers or anywhere near the elbow joint, foot, toe and shoulder. Usually painless, but if it presses on a nerve it can cause pain, tingling, numbness or muscle weakness.
Exact cause why a ganglion cyst develops is not known. It grows out of a joint or the lining of a tendon, looking like a tiny water balloon on a stalk, and seems to occur when the tissue that surrounds a joint or a tendon bulges out of place.
Most commonly occur in women between the ages of 20 and 40.
Osteoarthritis: People who have wear-and-tear arthritis in the finger joints closest to their fingernails are at higher risk of developing ganglion cysts near those joints.
Joint or tendon injury: Joints or tendons that have been injured in the past are more likely to develop ganglion cysts.
Investigations such as X-rays, ultrasound or magnetic resonance imaging (MRI) — to rule out other conditions, such as arthritis or a tumour. MRIs and ultrasounds also can locate hidden (occult) cysts.
Treatment is usually only recommended if the cyst causes pain or affects the range of movement in a joint. The two main treatment options for a ganglion cyst are:
- Draining fluid out of the cyst with a needle and syringe – the medical term for this is aspiration
- Excision of the cyst using surgery
Observation. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms, your doctor may recommend just waiting and watching to make sure that no unusual changes occur.
Immobilisation. Activity often causes the ganglion to increase in size and also increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms and cause the ganglion to decrease in size.
Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it. The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid can be withdrawn.
Aspiration frequently fails to eliminate the ganglion because the “root” or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not removed. In many cases, the ganglion cyst returns after an aspiration procedure.
Aspiration procedures are most frequently recommended for ganglions located on the top of the wrist.
Surgery should be considered if your symptoms are not relieved by nonsurgical methods, or if the ganglion returns after aspiration. The procedure to remove a ganglion cyst is called an EXCISION. It is usually done under regional block and as an outpatient procedure and performed by a board certified plastic surgeon. Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion.
COMPLICATIONS OF SURGERY
The only risks for ganglion cyst removal are infections or inflammation. There is a small risk of damage to nearby nerves or blood vessels. Ganglion cysts recur after excision in about 5–15% of cases, usually because the cyst was not completely removed.
Excision is a much more reliable procedure than aspiration however, the stiffness that the patient may experience after the procedure eventually goes away. The formation of a small scar is normal.
Excision is typically an outpatient procedure. Patients should avoid strenuous physical activity for at least 48 hours after surgery and report any signs of infection or inflammation. A follow-up appointment should be scheduled within three weeks of aspiration or excision.
Excision may result in some stiffness after the surgery and some difficulties in flexing the hand because of scar tissue formation. There may be some tenderness, discomfort, and swelling after surgery. Normal activities usually may be resumed 2 to 6 weeks after surgery.