A ganglion cyst is a small lump just below the skin. It is fluid-filled, often of jelly-like consistency and typically occurs in the wrist and hand, around a joint.
What causes ganglion cysts?
Ganglion cysts are very common. The exact cause is not known; however, they are thought to be related to repetitive microinjury of the involved joint capsule, that causes a defect or a soft spot through which material can bulge out. Some risk factors have been implicated:
• Age: typically, in adults between 20 and 5 years of age
• Gender: women are 3 times more likely to develop ganglia
• Old injury or repetitive tasks
• Arthritis: people with hand arthritis commonly have a ganglion near their fingertip called mucous cyst.
Ganglion cysts typically overly a specific joint or tendon. The most common types are:
• Dorsal wrist ganglion: they arise in the back of the wrist; these are the most common type. They arise from the scapholunate ligament.
• Volar wrist ganglion: this is found in the front of your wrist. Sometimes, it can be in close proximity to the radial artery, which needs attention during removal.
• Mucous cyst: these arise in close proximity to the fingernail, on the back of the fingertip. They are typically associated with arthritis of the DIP joint, which is the furthest joint of your finger.
The first sign of a ganglion is the appearance of a lump in the wrist or hand. This may vary in size. Most of the time, it does not hurt at all and it only causes a cosmetic issue. Other times it can cause pain and inflammation, by mass effect.
Ganglion cysts are usually obvious during the physical exam. Your doctor may order a hand x-ray to assess for any further underlying pathology. An ultrasound or MRI scan may be used to confirm the diagnosis.
You don’t have to have your ganglion removed if it does not bother you. Treatment may include conservative measures or surgery. Conservative measures include:
• Observation
• Rest
• Bracing
• NSAIDS
• Aspiration in the office under local anaesthetic and steroid injection.
Aspiration is a valid option, especially if you want to delay surgery. However, it carries a recurrence rate of about 50%. So, there is a good chance that your cyst may come back. Surgery involves either open excision of ganglion cyst under local anesthetic, or arthroscopic excision, usually under general anesthetic. Results of surgery are excellent. There is still a risk of recurrence of about 5-10%. This is a day procedure under local anaesthetic. The patient goes home the same day with a small dressing and is encouraged to move their wrist right away.
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