What is a Ganglion Cyst?
A ganglion cyst is a soft-to-firm, round growth located on the wrist joint. Usually about 1-3 cm in diameter, it is non mobile. It can be found most commonly on the dorsal aspect of the wrist, but can occur on the volar side as well. This benign growth is tethered to the wrist joint by a stalk known as the pedicle. Less frequently, the pedicle may anchor the ganglion cyst to a flexor tendon in the wrist. The fluid contained within the walls of the cyst is thick and gelatinous, and is structurally different from the synovial fluid found in other joints. It is not associated with any underlying inflammatory process.
In some cases, a smaller ganglion cyst is nestled between the wrist joint and overlying tissues. Because of its size and covert location, this type of ganglion cyst may not be visible with the naked eye. A high degree of suspicion from an experienced clinician is needed to search for these occult ganglion cysts.
What Causes a Ganglion Cyst?
The true cause of a ganglion cyst is unknown. One likely explanation asserts that trauma or repetitive movement in the wrist causes injury. Injury causes a defect in the wrist joint which allows leakage of synovial fluid from the joint into the tissues that surround the wrist. The cells present in this area react with the synovial fluid to create the gelatinous material of the cyst, which is then walled off by the body, forming the ganglion cyst capsule and pedicle.
What are the Symptoms of a Ganglion Cyst?
Ganglion cysts are space occupying lesions and as such may cause variable amounts of discomfort or pain depending on size or location. Pain, if present, tends to be a constant, annoying, dull ache that may radiate up the arm. Ganglion cysts may be large enough to interfere with the range of motion of the wrist. If tethered to a flexor tendon, it may interfere with grip strength or movement of the associated fingers. A frequent complaint with dorsal ganglions is pain when extending the wrist such as pushing off from a seated position, doing a push up or a plank position in yoga.
How is a Ganglion Cyst Diagnosed?
A thorough history and physical exam are important tools that aid in diagnosis. In more complicated presentations, ultrasound may be used to confirm that the growth is indeed filled with fluid, and not a solid mass of other origin. If the mass is cystic, therapeutic needle aspiration may be employed to remove the contents of the cyst to confirm a ganglion cyst. MRI is used to look for smaller, occult ganglion cysts not visible with the naked eye. MRI may be needed to plan for surgery, especially in cases where the ganglion cyst is thought to be attached to an underlying tendon, or the symptoms mimic other conditions such as Carpal Tunnel Syndrome. MRI does have its limitations. Sometimes an MRI may not detect a ganglion cyst, and for these reasons, surgery is the best method for both diagnosis and treatment of a ganglion cyst. Once the cyst is removed, it can be sent to a pathologist for confirmation of the diagnosis.
How is a Ganglion Cyst Treated?
Ganglion Cysts can be treated either non-surgically or surgically.
Watchful and waiting can be used once it is determined that a Ganglion Cyst is, indeed, present. It is estimated that 50% of ganglion cysts may resolve on their own, although recurrence is extremely common. In actuality, they may just become smaller to later enlarge as more fluid refills it. The best candidates for watchful waiting are those without pain whose main concern is the cosmetic appearance of the cyst.
Needle aspiration is often employed to remove the fluid from a ganglion cyst. Needle aspiration is oftentimes paired with the injection of a medication into the ganglion cyst, such as celestone or hyalouronidase. Again, recurrence is extremely common.
Although recurrence is possible with surgical removal of the ganglion cyst, the odds of recurrence are much lower, about 5%. Surgery is considered the best treatment option for those with painful ganglion cysts or cysts which interfere with the function of the wrist. Successful, permanent removal of ganglion cysts involves the removal of the cyst, its pedicle, and the margin of the joint capsule or tendon sheath where the pedicle attaches. If the surgeon fails to remove any of these aspects, the ganglion cyst has a higher chance of recurrence. For this reason it is strongly recommended that an experienced surgeon who focuses on the hand and the wrist be sought out for this procedure.
How can Dr. Knight help you with a Ganglion Cyst?
Ganglion cysts are one of the most common wrist ailments, and throughout his career as a surgeon he has treated countless occurrences. His experience allows him to comfortably recommend the best possible treatment for a Ganglion cyst, one that both fits the patient and the condition.
Ganglion Cyst Videos
See Dr. Knight discuss his protocol for ganglion cysts. Click on video.
Ganglion Cysts of the Hand Animation Video
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