Ganglion Cyst (Kista Ganglion)
By: Weka Gunawan (ÇSP Wěkādigunawan)
Definition:
A ganglion cyst is a tumor or swelling on top of a joint or the covering of a tendon (tissue that connects muscle to bone). It looks like a sac of liquid (cyst). Inside the cyst is a thick, sticky, clear, colorless, jellylike material. Depending on the size, cysts may feel firm or spongy.
More common occur in women than in men
Ø The base of the fingers on the palm, where they appear as small pea-sized bumps
Ø The fingertip, just below the cuticle, where they are called mucous cysts
Ø The top of the foot
Causes
The cause of ganglion cysts is not known. One theory suggests that trauma causes the tissue of the joint to break down forming small cysts, which then join into a larger, more obvious mass. The most likely theory involves a flaw in the joint capsule or tendon covering (sheath) that allows the joint tissue to bulge out.
Symptoms and Signs
The ganglion cyst usually appears as a bump (mass) that changes size. It is usually soft, anywhere from 1-3 cm in diameter (about .4-1.2 inches) and doesn't move.
The swelling may appear over time or appear suddenly, may get smaller in size, and may even go away, only to come back at another time.
Most ganglion cysts cause some degree of pain, usually following acute or repetitive trauma, but up to 35% are without symptoms, except for appearance. The pain is usually nonstop, aching, and made worse by joint motion. When the cyst is connected to a tendon, I feel a sense of weakness in the affected finger.
When to Seek Medical Care
Whether you have symptoms or not, a ganglion cyst can benefit from medical evaluation. Your doctor can be sure that you have a ganglion cyst, keep you from worrying, and help decide on the best treatment plan for you.
A ganglion cyst does not need to have emergency treatment unless you have significant trauma. A routine check by either your primary doctor or a specialist in bones and joints (an orthopedist) should be enough.
Diagnosis
A physical exam is often all that is needed to diagnose a ganglion cyst. I used a penlight in the dark to see the liquid inside the bump.
The doctor may get further confirmation by using a syringe to draw out some of the fluid in the cyst (needle aspiration) or ultrasound. Ultrasound is an imaging procedure involving the use of sound waves, and this can to help evaluate the bump to see if it is fluid-filled (cystic) or solid. Ultrasound can also detect whether there is an artery or blood vessel causing the lump. Advantages of ultrasound detection are the fact that it is becoming more widely available, it's quick, it is inexpensive, and is a reliable imaging mode.
X-rays have very little use in ganglion diagnosis.
Your doctor may send you to a hand surgeon if the bump is solid or involves a blood vessel (artery).
Magnetic resonance imaging (MRI) is used to see the wrist and is very useful for ganglions. One drawback to this diagnostic method is the cost of the procedure
Ganglion Cyst Treatment
In the past, home care has included topical plaster, heat, and various poultices. It even extended to use of a heavy book to physically smash the cyst (sometimes this is called "Bible therapy"). That is why the ganglion cyst also well known as Bible Cyst! These forms of treatment are no longer suggested, however, because they have not been shown to keep the ganglion cysts from returning and could, in fact, cause further injury.
Medical Treatment
Many ganglion cysts (38%-58%) can disappear without any treatment at all.
Various treatments have been proposed over the years. Some include telling people with cysts without symptoms not to worry, using a needle to remove the cyst's contents (aspiration), or surgery.
Aspiration usually includes placing a needle into the cyst, drawing the liquid material out, injecting a steroid compound (which acts as an anti-inflammatory agent), and then splinting the wrist to keep it from moving.
Studies have shown up to 74% of people are cured after having the fluid drawn out with a needle one time. If you have the fluid drawn out three times, your possibility of being cured goes up to 85%, particularly with a cyst on the back of the hand.
If you compare aspiration/injection and surgical removal, in general, cysts return less often after surgery.
Surgery
Ganglion cysts are the second most common elective referral to a surgeon, carpal tunnel being the first. Surgical removal of the cyst is needed when the mass is painful, interferes with function (especially when the dominant hand is involved), or causes numbness or tingling of the hand or fingers. Surgery can involve simple removal of the cysts through a small incision in which a camera (arthroscope) is inserted to view the area or through a larger incision allowing the cysts and surrounding area to be seen directly. Arthroscopic surgery is becoming more common because of the smaller resultant scar and shorter healing times from the smaller incision.
Follow-up
After you have been diagnosed with a ganglion cyst and have chosen to have treatment, follow-up will be different based on what you have chosen to do.
After simple aspiration, your doctor may ask you to start moving the joint soon after the procedure. Most likely after surgery, your joint will be splinted for up to seven to 10 days. A splint is a hard wrap that will keep you from moving your joint.
Recent studies show that splinting for a long period of time doesn't really help, and use of the joint soon after treatment is being encouraged.
Your doctor may ask you to return for a checkup after your surgery and will decide if physical or occupational therapy is needed. Follow-up care will be based on your personal needs.
Prevention
Prognosis
