What is Ganglion Cyst?
Ganglion cysts are lumps filled with a jelly-like substance, often seen in orthopedic medical care. We don’t fully understand why these cysts develop, but they’re thought to be caused by repeated minor injuries, leading to changes in the tissue that connects parts of your body. The most common place to find these cysts is in the hand and wrist, but they also frequently occur in the knee and foot.
Many people with ganglion cysts have no symptoms, but some might experience pain, tenderness, weakness, or dissatisfaction with the look of the affected area. Both non-surgical and surgical treatments exist, but non-surgical options have a high chance of the cyst returning. Surgery can remove the cyst and relieve symptoms, but it’s important to understand the nearby anatomy to avoid damaging any nerves or blood vessels close to the cyst.
What Causes Ganglion Cyst?
There’s no firm agreement about what causes ganglion cysts, but numerous theories have been proposed. One of these theories, suggested by Eller in 1746, is that ganglion cysts come from joints’ synovial tissue pushing outwards.
Another theory, put forward by Carp and Stout in 1926 and still widely believed today, suggests that ganglion cysts are due to damage overtime to connective tissue that becomes mushy or jelly-like.
Most experts nowadays generally agree that ganglion cysts come from a certain type of cell found where the synovial and the protective joint cover meet as a result of continuous small-scale injuries. Frequent damage to the supportive tissue and bands around the joints seems to stimulate specific cells to produce hyaluronic acid. This acid builds up and forms the jelly-like material that’s often found in ganglion cysts.
Risk Factors and Frequency for Ganglion Cyst
Ganglion cysts are soft-tissue masses that make up about 60% to 70% of those found in the hand and wrist. While these cysts can appear at any age, women between the ages of 20 and 50 are most often affected. In fact, women are three times more likely to develop a ganglion cyst than men. Gymnasts also frequently experience these cysts, likely due to continuous strain and damage to the wrist joint.
- Ganglion cysts contribute to about 60% to 70% of soft-tissue masses in the hand and wrist.
- They can form at any age, but are usually found in women aged 20 to 50.
- Women are three times more likely to get ganglion cysts than men.
- Ganglion cysts are commonly seen amongst gymnasts, probably because of the constant wrist stress and trauma.
Signs and Symptoms of Ganglion Cyst
Ganglion cysts mostly don’t cause symptoms. However, people might want them treated due to their appearance. Some might experience pain, tenderness, or weakness that gets worse when moving the wrist. Ganglion cysts are generally felt as firm, well-defined, movable lumps, ranging from 1 to 3 cm in size, typically attached deep under the skin rather than to the skin itself. Some patients with ganglion cysts on the palm side of the wrist may experience conditions like carpal tunnel syndrome or a “trigger finger” due to pressure on the median nerve or the tendon sheath that makes your fingers bend. They might also cause weakness in the ulnar nerve and pressure on the radial artery leading to poor blood flow. A notable feature of ganglion cysts is their ability to let light pass through when examined under a light source.
Testing for Ganglion Cyst
Your doctor may order X-rays to check for bone-related problems, but typically, these tests don’t show anything unusual. Normally, an MRI scan isn’t necessary for ganglion cysts unless there’s a suspicion of a solid tumor. If an MRI is done, it would show a well-defined mass filled with fluid. An ultrasound can be helpful to tell the difference between a cyst and a blood vessel abnormality, and it can also guide doctors to avoid accidentally hitting the radial artery during a procedure to extract fluid from the cyst.
Treatment Options for Ganglion Cyst
Patients who have ganglion cysts but aren’t experiencing symptoms can be reassured that these cysts are harmless and may go away on their own. Depending on where the cyst is located, non-surgical treatment can be considered. Cysts on the back of the wrist can be drained, but they’re more likely to come back compared to if they were removed with surgery. Draining of cysts on the palm-side of the wrist is typically not done because they’re too close to a major artery.
Surgery is an option for patients who continue to have symptoms and for whom non-surgical treatments haven’t worked. The removal of these cysts is usually an outpatient procedure, meaning patients can go home on the same day. For cysts on the back of the wrist, the surgeon makes a cut directly over the cyst. They then carefully dissect or separate the cyst from the surrounding tissue, attempting to avoid breaking it, which could make removal more difficult. It’s important that the surgeon removes the stalk, or pedicle, of the cyst and its attachments close to a nearby ligament. If these parts are not fully removed, the cyst is more likely to grow back.
Cysts on the palm-side of the wrist are often close to a major artery, and sometimes they may even wrap around it. The surgeon uses careful techniques to separate the cyst from the artery, trying not to injure the vessel. There’s also a branch of a nerve that’s at risk during the removal of these cysts. The most common problem after surgical removal is that the cyst grows back, and this is more frequent for cysts on the palm-side of the wrist. About 15-20% of ganglion cysts come back after being removed.
What else can Ganglion Cyst be?
When a doctor diagnoses a bone-related problem, they might check for various types of bone conditions. Some commonly known conditions they might consider include:
- Aneurysmal bone cyst, which is a fluid-filled sac inside the bone
- Chondroblastoma, which is a rare type of bone tumour
- Chondromyxoid fibroma, another type of benign bone tumour
- Enchondroma, a type of noncancerous bone growth
- Giant cell tumor, a rarely occurring bone tumor
- Nonossifying fibroma, a benign bone tumour that majorly occurs in children and teens
- Osteoid osteoma, a type of bone tumour that usually occurs in long bones
- Osteoblastoma, a rare and benign bone tumour
- Simple bone cyst, which is a hollow area in the bone that may contain fluid
It’s crucial for the doctor to explore all these possibilities and conduct necessary tests to reach an accurate diagnosis.
