The underlying cause of ganglion cysts is unknown but they
often occur in women between the ages of 20 and 40. Although common on the
wrists, they can also appear on the finger joints, around the knee and ankle
joints and along the top of the foot. Ganglion cysts often feel spongy and
squishy, but some can be firm and solid.
Ganglion cysts are easy to diagnose as they present very
differently to bone problems or cancerous lumps. Their location near to the
joints, their obvious visibility and their pliable nature make them easy to
spot.
What is a ganglion cyst?
A ganglion cyst is a small lump or sack of fluid beneath the
skin that forms at joints. It is particularly common to develop a ganglion cyst
around the wrist behind the hand. The cyst contains a thick, jelly like fluid
similar to the synovial fluid that lubricates joints and can range in size from
a small pea-like lump to a mass that can be an inch in diameter.
Why have a ganglion cyst treated?
There is no medical reason to have treatment. Ganglion cysts
are benign, they cannot spread to other parts of your body and they are not
contagious. However, there are a few practical reasons for seeking medical
advice:
- The lump may look
unsightly and cause embarrassment.
- The lump may
press on a nerve, compromising the function or sensation in the wrist or
fingers.
- Nerve pressure
may also cause pain. This may occur locally or it can be felt as referred pain
in adjacent areas.
- The ganglion cyst
may cause localised inflammation and the affected area can be sensitive to
touch.
- The cyst itself
may become inflamed and painful, causing a steady throbbing sensation.
How can a ganglion cyst be treated?
Although it is hard to believe in this day and age, the
traditional treatment for a ganglion cyst was to hit it with a heavy book or
bible to burst the cyst. Such cysts are often referred to as ‘bible bumps’ for
just this reason. Fortunately, this method of bursting them is no longer
recommended.
There are essentially three options for treating a ganglion
cyst; aspiration, surgery and leaving it to heal itself. Each has advantages
and disadvantages.
Aspiration of the ganglion cyst
During the aspiration procedure, a small needle is inserted
into the ganglion cyst and the fluid is drained out. An anti-inflammatory
steroid is often injected back into the cyst site to prevent re-growth. The
wrist is splinted for around a week to allow time for the site to heal.
The main advantage of aspiration is that it does not require
invasive surgery. However, its success rate is not brilliant and around 50% of
aspirated ganglion cysts grow back. This is because the procedure leaves the
cyst wall intact, allowing it to refill from the original source over a period
of time.
Surgery to remove the ganglion cyst
Surgery to remove the ganglion cyst wall as well as the
fluid within it has a much higher success rate. Only between 5% and 10% of
ganglion cysts grow back after being removed completely by an operation.
However, this success rate must be balanced with the risks associated with
invasive surgery, particularly in the wrist as so many vital nerves and tendons
pass through this area.
Surgery to remove a ganglion cyst requires a more invasive
surgical procedure than most people expect. This is not just a minor operation.
The surgeon must remove the cyst and often some of the underlying tissue too,
such as the nerve sheath or joint lining. This is to ensure that the source of
the cyst is fully dealt with.
This is why it usually takes around six weeks to recover
from surgery, which can be a major inconvenience, especially if the operation
is performed on your dominant hand.
Leaving the ganglion cyst alone
In many cases, the best treatment is to do nothing. Most
ganglion cysts fade with time, and even if they subsequently return, they do
not really pose any serious risk to health.
During ‘flare-ups’ the cyst can be managed by a combination
of standard painkillers, such as paracetemol, and ice packs to reduce swelling
in area around the cyst. If movement causes discomfort, you can also splint
your wrist temporarily.
So how should I deal with a ganglion cyst?
Given the low success rate of aspiration treatment and the
high risks of surgery, it is generally best to let ganglion cysts run their
natural course, unless they are causing you specific problems. Most will simply
go away on their own; you just need to give them time and have a little
patience.
