GANGLION CYSTS

WHAT IS A GANGLION CYST?

A ganglion cyst is the most common mass that develops in the hand and wrist. 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.

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 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 decrease range of 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 attached to the overlying skin and firmly attached to the underlying joint or tendon sheath. X-rays are sometimes helpful in diagnosing ganglions cysts, particularly about the distal interphalangeal joint where associated degenerative arthritis is often found. As other lesions can produce swelling in the same sites as ganglions, a 100% accurate diagnosis cannot be given without aspiration or excision of the mass.

HOW IS IT TREATED?

 Ganglions cysts often change in size and may even disappear on their own. 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 may diagnose the lesion and temporarily or permanently treat the condition. 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 an aspiration. The most reliable method of treating a ganglion cyst is by surgical excision. Usual recovery time following surgery ranges from 2 weeks for small ganglions of the finger, and 6 weeks for ganglions involving the wrist.