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.