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Ganglion cysts and how to remove them
Ganglion cysts are small, benign, fluid-filled sacs. They can be attached to joints or arise from a tendon sheath that covers the tendons.
They most commonly affect the wrist and hand, but can occur on the ankle, foot, or knee. They form small lumps under the skin.
The cysts are not cancerous and they are usually harmless. If they cause pain, make the joint difficult to use, or are particularly unsightly, they can be removed.
Ganglion cysts mostly affect people between the ages of 15 and 40, and women are more susceptible than men. They are quite common, but relatively little is known about them.
Fast facts on ganglion cysts
- Ganglion cysts are not cancerous, but how they form is unclear.
- Half of all ganglion cysts go away without intervention.
- The fluid in the cysts is similar to that in synovial joints.
- Drainage or surgical removal of the cysts can prevent them from returning.
- They are most common next to the wrists, but can affect the feet.
What is a ganglion cyst?
Ganglion cysts were first mentioned before Hippocrates, but even now they are a mystery.
They appear, often on the back of the hand, as a round or oval lump filled with fluid. They can range from the size of a pea to that of a golf ball.
Under the skin, the cyst resembles a water balloon on a stem.
A cyst is not a significant medical threat, but it can be worrying at times.
If it presses on a nerve, it can cause pain or make some movements difficult. It can sometimes be a cosmetic problem because of the size.
Ganglion cysts can usually be recognized by their characteristics.
Location: They are always near a joint, mostly on the upper or back wrist, but possibly on the inside of the wrist, on the palm of the hand at the base of a finger, or on the tip of the wrist joint of a finger. They can appear on the top of the foot, on the ankle, or sometimes on the knee.
Pain: It may or may not be painful. When they press on a nerve, there may be pain.
Shape and size: They are roughly circular in shape and less than an inch (2.5 centimeters) wide or the size of a golf ball. Some are very small. They may be felt as lumps under the skin, or they may not be noticeable at all.
They can be soft or hard, and they should move freely under the skin.
A ganglion cyst that occurs at the base of the finger can feel like a pea-sized lump under the skin.
If the cyst is on a finger joint, it can be an arthritic spur, the skin over the cyst can be thin, and there can be a groove over the fingernail that is just above it.
Sometimes the area around the cyst can feel numb and the grip on the affected hand can be reduced.
What causes a ganglion cyst is not yet known, but it can happen when connective tissue breaks down around a joint. They tend to be attached to an underlying joint capsule or tendon sheath.
They appear to grow from joints like a balloon on a stem, and they tend to develop in areas where a joint or tendon naturally bulges.
Risk factors appear to include:
Age and Gender: Ganglion cysts can affect anyone at any time, but they most commonly occur in women between the ages of 15 and 40.
Joint or tendon injury: Areas injured in the past are more likely to develop ganglion cysts.
Overuse: People who use certain joints a lot are more likely to develop ganglion cysts. Female gymnasts, for example, are particularly vulnerable.
Osteoarthritis: People with osteoarthritis of the joints near their joints are more likely than others to develop this type of cyst.
Trauma: It can result from a single incident or from repeated minor injuries.
What exactly leads to the formation of ganglion cysts is not fully understood.
Here are three possible causes, all related to joint stress.
- Joint stress can cause the joint capsule that surrounds the joint to split. As a result, synovial fluid leaks into the tissues around the joint. Reactions between the fluid and the tissue then form the thick cystic fluid and the cyst wall.
- Joint stress can cause connective tissue to break down in this area. Then, if fluid builds up, a cyst may form.
- Joint stress could cause mesenchymal cells to stimulate mucin secretion.
Mucin is a component of mucus, and mesenchymal cells are cells that can develop into a number of different cell types.
The fluid within a ganglion cyst is similar to the normal synovial fluid of the joint. A ganglion cyst appears to develop when the fluid leaks from the area around the joint and collects in a sac.
How or why this happens is not entirely clear.
The fluid in the ganglion cyst is thicker than normal synovial fluid. It consists mainly of hyaluronic acid, a compound common in connective tissue. It also contains lower amounts of glucosamine, globulins, and albumin.
There are three theories about where the fluid is coming from.
- It can start in the joint itself, with movement of the wrist pumping fluid into the cyst.
- This can happen when an area outside the joint degenerates, causing cysts to form.
- Mesenchymal cells within the cell walls could produce the fluid.
A person could experience all of these changes.
To diagnose a ganglion cyst, the doctor will usually shine a light through the cyst to see if its contents are transparent or opaque. The liquid will be clear and thick.
An X-ray, ultrasound, or MRI scan can help rule out other serious consequences such as cancer, arthritis, or other joint or bone problems.
A routine x-ray may not show a ganglion cyst and the x-ray will be normal unless there are changes related to arthritis.
When a ganglion cyst is not causing discomfort or pain, it often stays as it is. About half of ganglion cysts resolve without intervention, but they can take years to completely disappear.
Watchful waiting: Many ganglion cysts are lost without treatment, but if the cyst is on the foot or ankle the person must wear shoes that will not rub or irritate the cyst. Putting a pillow in the shoe can help.
Immobilization: Moving the affected area can increase the size of the cyst. Applying a splint or bracket to the area will limit movement. This can cause the cyst to shrink in size.
If there are other problems, such as if the cyst is pressing on a nerve and causing pain, treatment is possible.
If the cyst is painful, an over-the-counter (OTC) drug like ibuprofen can help.
Wearing softer or open-toed shoes, adding padding, or changing the lacing of the shoes can help.
People are not advised to follow any traditional means of hitting the cyst with a heavy object as it is unlikely to solve the problem and could cause further damage to the area. After that, it usually occurs again.
People should not "crack" the cyst as this can lead to infection and is unlikely to remove the cyst.
If the cyst is large or causing additional problems, removal may be required.
Aspiration: The fluid in a cyst is similar to that in the joints. By removing the cyst, the cyst can be permanently removed. A doctor can start injecting an enzyme into the cyst. This breaks the liquid down into a less thick consistency, which makes it easier to drain. However, the cyst can come back if the "root" remains.
Open surgery: the surgeon makes a small incision and removes the cyst along with the stem.
Keyhole surgery: the surgeon makes a small incision and inserts a camera into the affected area. The camera guides the process. This is less painful than open surgery and there is a low rate of recurrence. However, it has been reported that the recurrence rate is still close to 30 percent.
After surgery, the patient should keep the area covered and protect it from bumps.
If the cyst was on one hand or wrist, you may need to wear a splint for a few days.
OTC pain relievers can help when there is pain. There may be discomfort, bruising, and stiffness, but these should resolve pretty soon.
Keeping the limb raised can prevent swelling. If the discomfort persists, the person should see their doctor.
Removing the cyst does not guarantee that it will stay away. Surgery is less likely, but it can lead to complications and permanent scarring.
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