Ganglion cyst

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 13, 2016
StartDiseasesGanglion cyst

Ganglion cysts are non-cancerous, fluid-filled lumps that are found in the joint areas of the body just underneath the skin. Though they can appear at any joint region, ganglion cysts are most commonly found in the wrist area.

Contents

Definition & Facts

Ganglion cysts are sacs that are filled with a clear, thick fluid. This fluid is similar to the liquid found in joint regions that serve as lubrication for the area. The cyst itself grows out of the tissues that surround the joint such as ligaments and tendon sheaths.

Some appear and disappear quickly, while others develop slowly and take longer to dissipate. Their sizes vary, and multiple cysts can grow at the same location. Ganglion cysts are more commonly found in women and the highest number of individuals with them tend to fall in the 20 to 40-year-old age group.

Symptoms & Complaints

The first sign of a ganglion cyst is usually the appearance of a lump somewhere in the joint area. They are typically found in the wrist or ankle region, but can also emerge at the knees, hips and shoulders. Cysts may appear suddenly or may increase in size over time. It is also possible to have ganglion cysts that disappear only to come back later in time.

The cysts are found just underneath the skin. They are soft and stay stationary in the area in which they are located. The overall diameter of ganglion cysts varies, but typically is between one and three centimeters. There is commonly no other symptom other than the visual appearance of the cyst; however, if the cyst is located in a position where it is pressing on a nerve, the afflicted may feel a tingling sensation or pain and may experience weakness in the muscle.

Causes

The exact cause of ganglion cysts has not been proven, but there are a few theories that may explain this occurrence. One theory proposes that trauma which occurs to a joint area causes the surrounding tissue to break down. This tissue disintegration forms small cysts that combine to form a larger mass.

Another more commonly accepted theory involves herniation. This theory suggests that the site where a ganglion cyst appears developed with a flaw in the tendon sheath or joint capsule. It is this flaw that allows the connective tissue of the joint to bulge out.

Diagnosis & Tests

To diagnose a ganglion cyst, doctors will typically begin by visually inspecting the area. They will discuss with the patient their medical history and get a general idea of the details of the symptoms. They will investigate how long the cyst has been present, whether there have been any changes in the size or structure of the cyst and whether the cyst causes pain in the patient.

The fluid located inside the ganglion cyst is translucent, so doctors may shine a penlight around the area to see if the light passes through the cyst. By pressing on the cyst and the surrounding area, doctors can determine the tenderness of the affected area.

If there are uncertainties, X-rays may be ordered to rule out other causes of the lump such as arthritis or a bone tumor. In severe cases, a patient may be sent for an MRI. This typically happens when there is a cyst that is not visible or in an instance where it is necessary to distinguish the cysts from other tumors present in the patient.

Treatment & Therapy

Most ganglion cysts require no treatment at all. Patients will just need to keep an eye on the area to make sure there are no enlargements or significant changes until the cyst dissipates back into the tissue. If the cyst is painful, interferes with function of the afflicted joint, or has an appearance that is not considered normal, additional treatment will be required. It may just be recommended that the patient wear a wrist brace or other joint splint in order to restrain the cyst and prevent it from pressing on nerves.

Severe cases, such as those causing intense pain or that limit that range of motion of the joint area may require aspiration. This is where the doctor will drain the fluid from inside the ganglion cyst. This process begins by the doctor numbing the area surrounding the cyst. Then the cyst will be punctured by a needle and the fluid drained out.

Should a cyst return after previous treatment, surgery may be required. This treatment, called an excision, involves removing not only the cyst itself, but also the part of the joint capsule or tendon sheath where the cyst is anchored. This part is considered the root of the cyst and can cause the cyst to regrow if not removed. Excisions are typically an outpatient procedure.

It is highly recommended that a doctor decide the best course of treatment and that home remedies be avoided. Ganglion cysts are also known as Bible cysts for the fact that in the past standard treatment included smacking the cysts with a book. While this treatment may work initially by breaking up the cyst, it may not keep the cyst from growing back because it does not address the underlying problem. Home remedies may also cause injury and therefore shouldn’t be used.

Prevention & Prophylaxis

Because the exact cause of ganglion cysts is unknown, it's difficult to know how to prevent them from forming. Exercises and stretches that work joints can help to promote optimal range of motion and can help reduce the likelihood of ganglion cyst formation.

Avoidance of situations which may cause trauma to joint areas is also recommended. Perhaps the best course of action is to seek a professional evaluation of the cyst as early as possible. This will help decide the best and least invasive course of treatment.