Ganglion

Definition: What is a ganglion cyst?

A ganglion cyst, also known as synovial cyst, refers to a ball-shaped bulge in the synovial membrane which is filled with synovial fluid. It can typically be palpated as a firm but elastic prominence close to a joint, frequently at the wrist.

In most cases, a ganglion cyst will grow to size within a few weeks and since it is connected to the joint space and therefore the joint liquid, it may change its size. Such cysts usually vary in size from a few millimeters to several centimeters.

Often, it does not bother the patient at all and is only cosmetically unpleasant. The nodule itself is generally painless, although it may limit mobility as it grows in size, resulting in pain on exertion. Also, surrounding nerves or blood vessels may be compressed by it, leading to discomfort such as numbness, tingling or weakness and even paralysis of the innervated muscles.

It is less common for a ganglion cyst to arise from a tendon sheath. Women are more frequently affected than men, and ganglion cysts appear more often between 20 and 40 years of age.

How and where could a ganglion cyst form?

In most cases, the precise origin of a ganglion cyst remains unclear. It is thought to occur spontaneously, but also as a result of chronic overload and stress on the affected joints. The affected joints might respond to this stress by producing more synovial fluid and furthermore, the stress might make synovial membranes more prone to defects.

Connective tissue deficiency may also contribute to this process. In this way, outpouchings can develop, becoming visible as ganglion cysts. Also degenerative diseases such as osteoarthritis or injuries to the joints, for instance after an accident, can pose a risk factor for a ganglion cyst to form.

Ganglion cysts most often arise on the hand, particularly on the back of the hand, the fingers or the wrist. The development of cysts near the feet or knees is less commonly observed. Occasionally, ganglion cysts occur the hip, spine, elbow or shoulder.

Is a ganglion cyst dangerous?

Ganglion cysts are benign and harmless lesions. There is no risk of malignant transformation (development of cancer) or other life-threatening disorders.

At what point should a ganglion cyst be removed?

A ganglion cyst should only be treated if it causes discomfort. If the patient suffers from pain, restricted range of motion, numbness or paralysis, treatment should be taken into consideration.

Most patients seek medical advice mainly to clarify that the lump which they found is not a malignant tumor, or because they dislike the cyst for cosmetic reasons. Treatment can be indicated in such cases as well.

The physician is able to diagnose a ganglion cyst by a careful clinical examination, light fluoroscopy of the bulge and ultrasound examination.

Some ganglion cysts disappear on their own over time. At first, a conservative approach can be recommended, which includes immobilizing the affected joint for some time and resting it. In the event of repeated strain, however, the cyst may return. Furthermore, a puncture of the synovial cyst or surgical removal can be performed.

Can I treat a ganglion cyst myself?

Way back in the past, ganglion cysts were often treated by patients themselves using a hammer or a heavy book to forcefully squeeze or destroy the ganglion cyst. This is actually referred to as the Bible or hammer therapy.

Nowadays, patients are urged to refrain from this procedure. There is a high risk of injury to the joints and bones, resulting in inflammation, chronic pain and restricted range of motion.

Some ointments and home preparations are also available to treat ganglion cysts, although their efficacy has not been proven with certainty in many cases.

Patients can contribute to the shrinkage or disappearance of the synovial cyst by resting the affected joint and preventing overloading and improper loading. Also bandages or massages can help.

What is the surgical procedure for removing a ganglion cyst?

It is possible to puncture a ganglion. This involves piercing the cyst from the outside through the skin with a needle and drawing out the fluid it contains (aspiration). Unfortunately, the ganglion cyst may return, as the therapy does not treat the cause. Furthermore, certain medications (such as cortisone) can be injected to stop it from swelling again.

Alternatively, it can be treated surgically. This is done primarily in the case of very large or recurrent ganglion cysts that cause considerable discomfort and impaired function. There is no need for general anesthesia, as this surgery can be performed under local or regional anesthesia. If a ganglion cyst is removed on the fingers, hands or feet, then a so-called tourniquet can be placed.

By reducing the blood flow significantly this way, surgeons gain a clearer view and major bleeding can be prevented. The ganglion is completely removed through a small skin incision and the connection to the joint is sealed in the best possible way so that the cyst cannot reappear. Sometimes the operation can also be performed minimally invasive, as part of an arthroscopy.

After surgery, the joint should be immobilized for a short time, followed by early movement that may be supervised by a physiotherapist to prevent joint stiffening. The surgical area should be rested for several weeks, but patients can still move it appropriately.

Which doctors specialize in the treatment of a ganglion cyst?

Orthopedic and trauma surgery specialists take care of the diagnosis and treatment of a ganglion cyst. Treatment can be done both on an outpatient basis the doctor's practice as well as in the hospital.

Generally, patients can also visit their family doctor, who can diagnose a ganglion cyst and follow up on its progression and, should it be necessary, refer their patient to an orthopedic surgeon.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

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