Ganglion Cyst: What Is It?

Are Your Symptoms Due to a Ganglion Cyst?

Ganglion cysts are a very common reason patients may seek an evaluation by a hand surgeon. The ganglion can bother patients for a number of reasons and all of the potential symptoms can be reason enough for treatment. Some cysts cause pain while others are an unsightly mass that patients wish could go away. The most important thing to know, is that ganglion cysts are benign masses (NOT cancerous). Ganglion cysts typically rise from either a joint, such as the wrist, or sometimes other sites like a tendon. The lubricant fluid in joints is called synovial fluid and if the capsule that holds the fluid inside the joint has a little opening, the fluid can leak out and get trapped in a soft sac.  Our joints make synovial fluid every day of our lives and that same style of fluid lives around tendons as well to allow those tendons to glide smoothly. The small cyst process can occur around tendons.  As you can see, the cysts themselves are like balloon sacs attached to a fluid generator. This is why cysts can sometimes get bigger or smaller over time depending on fluid flows that naturally occur through life.  When ganglion cysts occur from a joint, it is important to delineate if that joint is arthritic or not because cysts that rise from arthritic joints may have need different treatment in order to predictably delete them.  

Ganglion cysts themselves aren't known to be a terribly painful thing except that we know they are an extra space-occupying mass which can certainly push on surrounding structures in a symptomatic and/or annoying way.  

What do we do about them?

In my opinion, there are three treatment styles for ganglion cysts. Certainly the easiest treatment is to leave them alone.  If indeed your mass is a ganglion cyst, then as mentioned above, it's important to know they are not harmful to exist.  They are safe to live there forever.  By the time patients arrive to our office, these ganglion cysts typically have at least started to cause some degree of annoying or painful symptoms.  The two strategies to get the cysts to go away are needle aspirations or surgical excision.  Needle aspiration is an in-office procedure which can be used to take the cyst fluid out and sometimes even to try to make several punctures in the cyst to try to prevent recurrence.  The problems with aspirations are that the procedure can't address the fluid generator (joint or tendon where the cysts are rising from) and some integrity of the cyst cavity always remains.  Despite being an easy, in-office procedure, the recurrence rate can be quite high after needle aspiration attempts.  

Surgical excision is the most robust strategy we as hand surgeons can employ to get rid of these cysts although recurrence of the cysts can still be an issue.  On average, patients can expect between 5% and 10% recurrence rate after a removal surgery.  The standard surgery involves making an incision over the cyst and resecting the whole cyst cavity.  We also have various strategies in surgery to try to get rid of the one-way-valve phenomena of the cyst stalk coming from the joint. If the cyst has been coming from a joint that has arthritis, the recurrence rate can be quite a bit higher than those numbers quoted earlier.  Sometimes, the arthritis needs treatment directly to prevent the cysts from coming back.  A newer concept in removing wrist ganglion cysts specifically, can be minimally invasive arthroscopic removal.  This involves really small incisions on the back of the wrist and working to take the cyst out from deep within the joint.  It is still a little unclear if this technique has any advantages with regard to recurrence rates over the typical open incision technique that is most common. 

Each patient has an individual experience with their cysts and we certainly see that variety in the patients that come to our practice.  Symptoms can be different, size and location can be different, and certainly the treatment strategies can be very different for each and every patient.  Individual treatment is important.  We would be happy to take a look and chat with you about your cyst any time.  Don't hesitate to reach out to make an appointment today! 

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