What is a Ganglion Cyst?
A ganglion is the most common mass that develops in the hand.
Ganglion cysts are benign lesions. No cases of associated malignancy
have been reported. A ganglion can be described simply as a
fluid-filled sac arising from an adjacent joint capsule or tendon
sheath. A ganglion can form from almost any joint or tendon sheath
in the wrist and hand. Your Indiana Hand Center physician will
review this with you during your appointment.
What are the Causes?
The exact cause of ganglions remains uncertain. The most popular
theory is that ganglions form after trauma or degeneration of the
tissue layer responsible for producing the synovial fluid which
normally lubricates the joint or tendon sheath. The cyst arises from
accumulation of this fluid outside the joint or tendon sheath in a
sac or cyst.
What are the Signs and Symptoms?
Ganglions may limit motion in the adjacent joints, or produce
discomfort from compression or distention of local soft tissues.
Particularly large ganglions can be cosmetically unpleasant.
Ganglion cysts of the distal interphalangeal (DIP) joint may produce
deformities of the fingernail. Ganglion cysts arising from the
flexor tendon sheath at the base of the finger may produce pain when
grasping. On rare occasions, ganglion cysts (particularly those
associated with the wrist) may cause changes in the bone.
Ganglion cysts can frequently be diagnosed simply by their location
and shape. They are usually not adherent to the overlying skin and
are firmly attached to the underlying joint or tendon sheath. Large
ganglions may permit the passage of light through their substance
(trans-illumination). X-rays are sometimes helpful in diagnosing
ganglion cysts, particularly about the distal interphalangeal joint
where associated degenerative arthritis is often found. The presence
of a grooved nail bed is a classic finding with a mucous cyst. As
other lesions can produce swelling in the same sites as ganglions, a
100% accurate diagnosis cannot be provided without aspiration or
excision of the mass.
How is it Treated?
Ganglion cysts often change in size and may even disappear
spontaneously. For this reason, if the ganglion is asymptomatic, it
may be best to simply observe the mass for a period of time.
Ganglions about the wrist may respond well to a temporary period of
immobilization if diagnosed early.
Aspiration of a ganglion by a physician may help diagnose the lesion
and may temporarily or permanently treat the condition. This
consists of first numbing the area with a local anesthetic and then
inserting a needle to withdraw the clear, jelly-like fluid from the
ganglion sac. A compressive dressing or splint may be applied
following aspiration. Aspiration is extremely useful in minimizing
symptoms when surgery is not desired. Recurrence of the ganglion can
be expected in up to 50% of cases following aspiration.
The most reliable method of treating a ganglion cyst is by surgical
excision. This is done on an outpatient basis. Ganglions in the
finger can be removed under a local anesthetic. However, those cysts
involving the wrist usually require a regional or general
anesthetic. The ganglion is removed through an incision directly
over the area of swelling. Care is taken to attempt to identify its
site of origin, and to excise a small portion of the joint capsule
or tendon sheath from which it has arisen. In the treatment of a
mucous cyst at the distal interphalangeal joint, it is important to
remove any osteophytes (bony spurs) that may be associated with the
origin of this type of ganglion.
What About Recovery?
Following ganglion cyst removal at the wrist level, a bulky
compressive dressing will be applied. A therapist will initiate
exercises early in the postoperative period. This is done to prevent
the development of possible stiffness and prevent limitations of
wrist motion. Between periods of exercise, a splint may be worn to
provide rest for the joint, or one may be worn to assist in
regaining motion. Usual recovery time following surgery for ganglion
cysts ranges from two to three weeks for small ganglions of the
finger, and six to eight weeks for ganglions involving the wrist.