Ganglion cysts

A ganglion arises out of a joint, like a balloon on a stalk. It grows out of the tissues surrounding a joint, such as ligaments, tendon sheaths, and joint linings. Inside the balloon is a thick, slippery fluid, similar to the fluid that lubricates your joints.

Ganglion cysts can develop in several of the joints in the hand and wrist, including:

• Both the top and underside of the wrist
• The end joint of a finger
• The base of a finger
• Over pully sheaths

They vary in size, and in many cases, grow larger with increased activity. With rest, the lump usually becomes smaller.

Causes:

It is not known what triggers the formation of a ganglion.

•  most common in younger people between the ages of 15 and 40
• women are more likely to be affected than men.
• They are common among gymnasts, who repeatedly apply stress to the wrist.

Ganglion cysts that develop at the end joint on the nail side of a finger — also known as mucous cysts — are typically associated with arthritis in the finger joint and are more common in women between the ages of 40 and 70.

Symptoms:

Most ganglions form a visible lump; however, smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms besides the appearance of a mass, if a cyst puts pressure on the nerves that pass across the joint, it can cause pain, tingling, and muscle weakness.

If you have a large cyst, even if it is not painful, you may feel anxious or unhappy simply because of how it looks.

Treatment:

Nonsurgical Treatment

Observation: If you have no pain or other symptoms, your Hand therapist may recommend just waiting and watching to make sure that no unusual changes occur. This is typically safe because ganglions are not cancerous and may disappear on their own in time.

Immobilization: Activity often causes the ganglion to increase in size, which may increase pressure on surrounding nerves, causing pain. A splint may relieve symptoms and cause the ganglion to decrease in size. As pain decreases, your Hand Therapist will prescribe exercises to strengthen the wrist and improve range of motion.

Aspiration: 

Unfortunately, aspiration often fails to eliminate the ganglion because the root or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not addressed. Thus, in many cases, the ganglion cyst returns after an aspiration procedure.

Surgical Treatment:

Your doctor may recommend surgery if your symptoms are not relieved by nonsurgical methods, or if the ganglion returns after aspiration. The procedure to remove a ganglion cyst is called an excision.

Surgery involves removing the cyst as well as addressing the stalk from which the cyst arises. This may mean removing part of the involved joint capsule or tendon sheath to ensure removal of the root of the cyst. Even after excision, there is a small chance the ganglion will return.

 There may be some tenderness, discomfort, and swelling after surgery. You are usually able to resume normal activities 2 to 6 weeks after the procedure. Your Hand Therapist will guide you through the recovery process post operatively.