Ganglion Cyst: Causes, Symptoms and Treatment

A ganglion cyst is a mass of tissue that is filled with a jelly-like fluid. The word "ganglion" means "knot" and is used to describe the knot-like mass or lump of cells that forms below the surface of the skin. Ganglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot--usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger over time and may even disappear, only to possibly return later.

Cause of Ganglion Cyst

The cause of ganglia is not completely understood, and there have been conflicting views on their origin. As mentioned earlier, ganglia can occur when there is a small tear in the ligament overlying a tendon sheath or joint capsule. Whether this is due to injury, a degenerative process, or a subtle abnormality is unknown.

Common sites for ganglions are

The wrist - on the back ("dorsal wrist ganglion"), on the front ("volar wrist ganglion"), or sometimes on the thumb side. These come from one of the wrist joints, sometimes aggravated by a wrist sprain.

The palm at the base of the finger ("flexor tendon sheath cyst"). These come from the tube which holds the finger tendons in place, and are often due to tendon irritation - tendinitis.

The back of the end joint of the finger ("mucous cyst"), next to the base of the fingernail. These can cause a groove in the fingernail, or rarely can become infected and lead to a joint infection. These are usually due to some arthritis or bone spurs in the joint.

Signs and Symptoms of Ganglion Cyst

Most patients notice a lump under the skin which most commonly is located on the back side of the wrist, on the palm side of the wrist, over a tendon at the base of a finger on the palm side, or on a finger at the joint closest to the fingertip. Ganglia are often painless; however, they may cause pain with movement or cause mechanical problems (limiting range of movement) depending on where they are located. They have a tendency to wax and wane in size, presumably as the fluid contained within the cyst drains back into the joint or tendon sheath and again produces fluid and fills.

The biggest problem with a ganglion may be the fear a patient may have that it is something more ominous. The diagnosis is based on the history, physical examination, and possibly plain x-rays or ultrasound. The cyst can be distinguished from a solid tumor by transillumination (light will pass through the hollow fluid filled ganglion, but not a solid tumor mass). Ultrasound imaging has also been used to differentiate between solid and cystic masses in the hand.

Treatment options for ganglion cysts

Treatment can often be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless. If the cyst becomes painful, limits activity, or is cosmetically unacceptable, other treatment options are available. The use of splints and anti-inflammatory medication can be prescribed in order to decrease pain associated with activities. An aspiration can be performed to remove the fluid from the cyst and decompress it.

This requires placing a needle into the cyst, which can be performed in most office settings. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available. Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath (see Figure 3). In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques may yield good results. Surgical treatment is generally successful although cysts may recur. Your surgeon will discuss the best treatment options for you.

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