Ganglion cysts

Ganglion cysts: Description, Causes and Risk Factors:Ganglion cystsA ganglion cyst is most common mass that develops in the hand. Ganglion cysts are benign lesions. A ganglion is a fluid-filled sac arising from an adjacent joint capsule or tendon sheath. A ganglion can form from almost any joint or tendon sheath in the wrist or hand.The exact cause of ganglion cyst remains uncertain. The most popular theory is that ganglions form after trauma or degeneration of the tissue layer responsible for producing the synovial fluid which normally lubricates the joint or tendon sheath. The cyst arises from accumulation of this fluid outside the joint or tendon sheath in a sac or cyst.Dorsal wrist ganglion cyst is the most common accounting for 60-70% of all hand and wrist ganglion cysts. Ganglions in this region usually are directly over the scapholunate interosseous ligament, though they appear anywhere between the long thumb extensor laterally and the common ?nger extensors medially.Volar wrist ganglion cysts account for 18-20% of all ganglion cysts of the hand and wrist. They generally occur under the volar wrist crease, just radial to the ?exor carpi radialis tendon. Volar ganglion cysts arise most frequently from the radiocarpal joint or the scaphotrapezial joint.Around 30-50% of ganglion cysts disappear by themselves without the need for medical treatment. However, it is always best to consult your physician to make sure the lump isn't a symptom of some other disease. If your ganglion cyst is painful, or if it interferes with your mobility or causes sensations of numbness or pins and needles, it is best to consult your physician and opt for treatment.Symptoms:Pain, weakness, and unsightly appearance are themost common presenting complaints of patientswith wrist ganglion cysts.Less typical presenting symptoms includecarpal tunnel syndrome or trigger digit resulting froma volar carpal ganglion cyst's interference with the?exor tendon sheaths.Diagnosis:The diagnosis is usually based on the location of the lump and its appearance. Ganglion cysts are usually oval or round and may be soft or firm. Cysts at the base of the finger on the palm side are typically very firm, pea-sized nodules that are tender to applied pressure, such as when gripping. Light will often pass through these lumps (transillumination), and this can assist in the diagnosis. Your physician may request x-rays in order to look for evidence of problems in adjacent joints. Cysts at the far joint of the finger frequently have an arthritic bone spur—which is a small bony bump or projection—associated with them, the overlying skin may become thin, and there may be a lengthwise groove in the fingernail just beyond the cyst.Histologically they are composed of a thin connective tissue capsule made up of compressed collagen fibres lined with flattened cells. There is no evidence of a synovial or epithelial lining. Cyst contents consist of a hyaluronic acid-rich mucin-filled uni- or multi-loculated cystic cavities with glucosamine, globulin and albumin. Malignant degeneration has never been reported.Treatment:Treatment can often be non-surgical. In many cases, the cysts can simply be observed, especially if they are painless, because they frequently disappear spontaneously. If the cyst becomes painful, limits activity, or is otherwise unacceptable, several treatment options are available. The use of splints and anti-inflammatory medications 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. Aspiration is a very simple procedure, but recurrence of the cyst is common.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. In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques usually yield good results. Surgical treatment is generally successful although cysts may recur. If there is any question about the diagnosis, excisional biopsy with a pathological examination will better define what the mass is. Your surgeon will discuss the best treatment options for you.Following ganglion cyst removal at the wrist, a bulky dressing with a plaster splint incorporated is worm for 10-14 days. Physiotherapy is then started to get the wrist moving again. It will take 3 months regain almost normal strength and movement, both of which will improve gradually. Recovery is rapid for tendon sheath ganglions (2-3 weeks) whereas distal interphalangeal ganglia take 6-8 weeks to recover due to the surgery to the joint bony spurs. Physiotherapy is not usually required for finger ganglion cysts.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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