Ganglion cysts are very common. The cyst are generally found on the top (dorsum) of the wrist (60-70%), the end joint of a finger (distal phalangeal joint), and at the base of a finger (palm-side). Ganglion cyst usually come up from nearby joint linings or tendon sheaths. These cysts can be painful, especially when they first appear and with constant or strenuous use of the hand or wrist. Ganglions often change in size and may disappear completely. These cyst are benign. There is no known specific cause for ganglions, but often there has been an injury before the appearance of the cyst. A ganglion cyst contains a thick, clear, mucus-like fluid similar to the fluid found in the joint. Women are more likely to be affected than men. Ganglia are common among gymnasts, who repeatedly apply stress to the wrist.
A ganglion grows out of a joint, like a balloon on a stalk. It rises out of the connective tissues between bones and muscles. Inside the balloon is a thick, slippery fluid similar to the fluid in your joints. Usually, the more active the wrist, the larger the cyst becomes. With rest, the lump generally decreases in size.
The diagnosis of a ganglion cyst is based on where the cyst is an d what it looks like. Your doctor may ask you how long you've had the ganglion, whether it changes in size, and whether it is painful. Pressure may be applied to identify any tenderness. A penlight may be held up to the cyst to see whether light shines through. X-rays may be taken to rule out other conditions, such as arthritis or a bone tumor. Sometimes, an MRI or ultrasound is needed to find a ganglion cyst that is not visible.
Treatment of ganglion cysts may consist of
- Doing nothing. The cysts are benign and if yours is not painful, does not limit activity, and its appearance is acceptable to you, then there is no reason for further treatment. Just watch it for changes.
- If it is painful, does limit activity, or you dislike its appearance, then treatment may include removing fluid from the cyst (putting a needle into the cyst and aspirating) and /or wearing a splint to keep the hand or wrist from moving.
- If these non-surgical treatments fail, surgery to remove the cyst can be done. This surgery is performed on an outpatient basis. Anesthesia may be local, regional (where only the arm is numbed), or general. The goal of surgery is to remove the source of the cyst. This may require removal of a portion of the joint capsule or tendon sheath next to the ganglion. If the ganglion is removed from the wrist, a splint may be recommended following surgery for a few weeks. Some patients may feel tenderness, discomfort, and swelling at the site, but full activity can be resumed once comfort permits. While surgery offers the best success in removing ganglions, these cyst can and do return.