A ganglion cyst is a noncancerous lump that commonly develops on or around joints and tendons in the hand and wrist. These cysts are filled with a thick, clear, jelly-like fluid that is similar to the fluid that lubricates joints and tendons. Ganglion cysts can also occur in other areas of the body, such as the foot and ankle. They are most common in women and people between the ages of 15 and 40.
Ganglion cysts are usually painless and do not cause any symptoms, but they can sometimes become painful if they press on a nerve or if the joint or tendon they are connected to becomes inflamed. Treatment options for ganglion cysts include observation, aspiration, and surgical removal.
History and Definition
Ganglion cysts are non-cancerous lumps filled with a jelly-like fluid, typically found at the back of the wrist or on the top of the foot. They may also occur in other areas such as the shoulder, elbow and ankle joints. The exact cause is unknown but is thought to be related to the overuse of tendons and joint capsules.
A variety of treatments are available for ganglion cysts, including observation, aspiration (draining) and surgery depending on severity and location. The aspiration of ganglion cysts must be performed by a qualified healthcare professional. Surgery involves removing the entire cyst with surrounding tissue from its origin within a tendon sheath or joint capsule. Following surgery, it’s important to rest and protect the area to prevent a recurrence.
Early diagnosis and treatment can help minimize the risk of permanent damage from a ganglion cyst. The first documented description of a ganglion cyst was attributed to T. Swinford Edwards in 1884, who identified a cadaveric specimen that affected the deep branch of the ulnar nerve and arose from a carpal joint. However, it is thought that they have been around since ancient times with descriptions dating back to Ancient Greece and Rome as well as references in traditional Chinese medicine texts.
Today, ganglion cysts remain common causes of hand pain but with proper medical evaluation and treatment, they are typically manageable conditions.
Symptoms
Symptoms of ganglion cysts can include:
- A visible lump or bump on the skin near a joint, such as a wrist, hand, or foot
- Tenderness or pain in the affected area
- Weakness or numbness in the affected joint
- A feeling of fullness or a sense of “clicking” in the affected joint
- In some cases, no symptoms at all
- It is important to note that these symptoms can also be caused by other conditions, and a proper diagnosis can only be made by a medical professional.
Causes
The exact cause of ganglion cysts is not well understood. They are thought to develop as a result of abnormal growths in the lining of the joint or tendon sheath, which can then fill with a thick, clear fluid.
Some possible factors that may contribute to the development of ganglion cysts include:
- Previous joint or tendon injury
- Osteoarthritis or other degenerative joint conditions
- Repetitive motions or overuse of the joint
- Genetic predisposition
It is also worth noting that ganglion cysts can occur in individuals of any age, and can affect both men and women. Again, a proper diagnosis can only be made by a medical professional.
Diagnosis
Diagnosis of a ganglion cyst typically begins with a physical examination and a review of the patient’s medical history. The doctor will examine the affected area and may press on the lump to check for any pain or discomfort.
Additional tests that may be used to confirm the diagnosis of a ganglion cyst include:
- Imaging tests such as X-ray, Ultrasound, MRI or CT scan
- Aspiration of the cyst, in which a needle is inserted into the lump to remove fluid for analysis
- Biopsy, in which a small sample of tissue is removed for examination under a microscope
It’s important to note that not all cysts are ganglion cysts, and other conditions may need to be ruled out before a definitive diagnosis is made. A proper diagnosis can only be made by a medical professional.
Treatment
Treatment for ganglion cysts can vary depending on the size, location, and symptoms of the cyst, as well as the preferences of the patient. Some possible treatment options include:
- Observation: If the cyst is small and not causing any pain or discomfort, the doctor may recommend simply monitoring it over time to see if it changes in size or symptoms.
- Aspiration: The doctor may use a needle to remove the fluid from the cyst, which can reduce pain and inflammation. However, there is a high chance of recurrence.
- Orthotic devices or splints: If the cyst is causing pain or weakness in the affected joint, the doctor may recommend using a brace or splint to keep the joint immobile and reduce stress on the cyst.
- Physical therapy: If the cyst is causing pain or weakness in the affected joint, physical therapy may be recommended to improve strength, flexibility, and range of motion in the joint.
- Surgery: In some cases, surgery may be recommended to remove the cyst and the overlying cyst wall. Surgery is usually recommended if the cyst is causing significant pain or weakness, or if it is interfering with the function of the affected joint.
Recovery after treatment may vary depending on the treatment performed. If the cyst is aspirated, the patient may experience some pain or discomfort at the needle insertion site. If surgery is performed, the recovery time can range from a few days to several weeks, depending on the extent of the surgery and the overall health of the patient. Physical therapy may be recommended after surgery to help the patient regain strength and mobility in the affected joint.
It is worth noting that Ganglion cysts may recur after treatment, and close monitoring by a medical professional is advised. It’s important to follow the doctor’s instructions and attend any follow-up appointments to evaluate the cyst’s progress and ensure proper healing.
Complications
Ganglion cysts are generally considered to be benign, however, they can cause complications in some cases. Some possible complications of ganglion cysts include:
- Pain or discomfort: The cyst may press on nearby nerves or tendons, causing pain or discomfort in the affected area.
- Weakness or numbness: If the cyst is located near a nerve, it may cause weakness or numbness in the affected area.
- Interference with joint function: If the cyst is located near a joint, it may interfere with the normal movement and function of the joint.
- Recurrence: Ganglion cysts may recur after treatment, particularly if the cyst wall is not completely removed.
- Tissue damage: In rare cases, if a cyst is left untreated for a long period, it can cause damage to the surrounding tissue.
- In rare cases, malignancy: Although very rare, a small percentage of ganglion cysts may be malignant, and a biopsy and further testing may be necessary to rule out malignancy.
It’s important to note that these complications are not common and most people with ganglion cysts do not experience any significant complications. However, if you experience any symptoms that concern you, it’s important to seek medical attention.
When to See a Doctor
A ganglion cyst is a fluid-filled sac that can develop near joints or tendons in the hand or foot. They are usually painless but can cause discomfort or affect the movement of the joint. If the cyst is causing pain, affecting joint movement, or is cosmetically concerning, it is recommended to see a doctor.
If the cyst is small and not causing any symptoms, it can be observed over time. However, if it begins to change in size or appearance, or causes symptoms, it is a good idea to see a doctor for evaluation. Additionally, if the cyst is painful or is located in a place that is prone to injury, it is also recommended to see a doctor.
Step-by-Step Guide to Ganglion Cyst Treatment
Treatment for a Ganglion Cyst typically begins with a consultation with a doctor, such as a primary care physician or hand or plastic surgery specialist. During the consultation, the doctor will take a medical history, perform a physical examination, and may order imaging tests such as an X-ray or MRI to confirm the diagnosis and determine the size and location of the cyst.
Step-by-step guide for Ganglion Cyst treatment:
Consultation
During the initial visit, the doctor will evaluate the cyst and may discuss the various treatment options available.
Observation
If the cyst is small and not causing any symptoms, the doctor may recommend observation over some time to see if it changes in size or causes symptoms.
Aspiration
If the cyst is causing pain or affecting joint movement, the doctor may recommend aspiration, a procedure in which the cyst is drained using a needle and syringe. This procedure can provide immediate relief, but the cyst may recur.
Surgery
If the cyst is recurrent, large or affecting the joint function, surgical removal of the cyst may be recommended. The surgery is usually done as an outpatient procedure and the recovery time ranges from a few days to a few weeks.
Physical Therapy
After surgery or aspiration, physical therapy may be recommended to help regain strength and range of motion in the affected joint.
It’s important to note that treatment options vary depending on the size, location, and symptoms of the cyst and the patient’s preferences. The doctor will explain the risks and benefits of each treatment option and help the patient make an informed decision.
Conclusion
In conclusion, a ganglion cyst is an abnormal lump or sac filled with fluid that can develop on the joints and tendons of the body. Although these cysts are often harmless and painless, they may cause discomfort or difficulty in movement if they press against a nerve.
Treatment options vary depending on the size and location of the cyst, as well as individual preferences. Surgery is usually recommended for larger cysts that cause persistent symptoms. With proper management, most people can successfully manage their ganglion cysts and live normal lives.
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If you are interested in setting up an appointment to discuss a ganglion cyst treatment plan with Dr. Hong, please contact his office at (416) 222-6986 or email us at info@drcolinhong.com. When making your request for consultation consideration, kindly provide your full name, email address and phone number so we may reach out to you as soon as possible. Additionally, it is recommended that you seek a referral from your primary care physician before booking an appointment.
Frequently Asked Questions
If the cyst is causing significant irritation or discomfort, it is recommended that you have the cyst removed.
This surgery attempts to remove the cyst intact which includes the fluid and the sac containing the fluid.
Risk include normal surgical risk such as wound infection and damage to surrounding tissue, which include the nerves and tendons that may run close to the cyst. Other possible risk includes joint infection and possible recurrence
A complete list of possible risks and complications and their explanation can be found at:https://www.drcolinhong.com/learn/risks-and-complications/ganglion-cyst/
If you are not experiencing any problems from the cyst, you may choose to not receive any treatments and with small cyst, it can go away on it's own. However, typical non-surgical management involves aspirating/expressing the fluid using a large size needle to open up the sac. (Please seek professional management as using non-sterile needles can causing infections to nearby joints and may cause injury to other areas the hand).
Removal of the cyst is not urgent and you can choose when it is convenient if you chose to have the cyst surgically removed.
The outcome of not intervening on these cysts can vary. Sometimes cyst may become larger, it may decrease in size and disappear and/or it can remain the same over long periods of time.
This is usually a minor surgery where an incision approximately the size of the cyst is made to remove the cyst intact. However, depending on the size and location of the cyst, sometimes surgical excision can be more extensive.
The range of reoccurrence is from 12-41% but this depends on the patient’s genetic predisposition as well as frequency of use.
Recovery time varies according to the size and location of the cyst. If the cyst is small, and superficial, it usually requires about 10-14 days for the incision to be completely healed and should not significantly affect the function of the hand/wrist (where it is most commonly located). However, if the cyst is more extensive in size or is located in areas that has caused significant distortion to the anatomy and function of the hand, it may require a more extensive recovery process, including some physical therapy for strength and stretching exercises.
The size of the scar will be approximately the size of the cyst. Over a 3-6-month duration, the incisional scar will fade in colour.
The size of the scar will be approximately the size of the cyst. Over a 3-6-month duration, the incisional scar will fade in colour.
Surgery usually takes about 20 minutes total. After consent is signed, an injection is made into the local area where the incision is made. After 10-15 minutes, when the anesthesia is in full effect, surgery is usually completed within 5-10 minutes.
There should be minimal pain after surgery. You may experience some soreness or bruise like sensation over the incisional site.
If you experience and post-operative pain, you should take some over the counter pain medications such as acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin).
Typically there is no packing or tubing in the surgical site. You should expect the surgical site to be dressed with some superficial dressing.
Depending on the size and location of the cyst, you may or may not need any physical therapy. If you need any physical therapy session, you will be notified at the completion of your surgery and we will help set that up for you.
It requires 10-14 days for the incision to be completely healed. During that time, there is no restrictions to activities exception for intense sports that may cause the sutures to open up. Prompt usage of the hand is actually encourage and will help with the recovery process.
You can drive immediately after surgery.
You can return to work the next day.
Local anesthesia is used for this procedure.
Since only local anesthesia is used, it is not required that you see an anesthesiologist
Your medication list will be reviewed prior to surgery. However, you should also review your medication with your family doctor as well.
Generally, blood thinners should be stopped prior to surgery. However, different types of blood thinners should be stopped for different durations prior to surgery. Your family physician should be consulted as to when and if you should stop your medication prior to surgery.
Typically no other tests is required prior to surgery. However, certain individuals on specific types of blood thinners may need a blood test immediately prior to surgery.
There are no diet and fluid restrictions prior to or after surgery.
You should arrive at your appointment time for surgery.
Please call the office at (416)222-6986 to see your scheduled date and time for your surgery. This surgery is usually performed at two different hospital sites: Mackenzie Health Center or Rouge Valley Centenary Hospital. Once your appointment is set, you will be directed to the correct site.
If comfortable, you should be able to drive after surgery.
- Arrange for someone to take care of responsibilities at home and work
- Call your doctor if you think of other questions
- Notify your doctor if you get sick within 10 days of your surgery (even minor illnesses like a cold)
- Do not smoke or drink alcohol 24 hours before your surgery
- Make sure you have the doctor’s contact information
- Make sure you have directions to the hospital/office for visitors
- Surgery usually takes about 20 minutes total. After consent is signed, an injection is made into the local area where the incision is made. After 10-15 minutes, when the anesthesia is in full effect, surgery is usually completed within 5-10 minutes.
- You are typically awake for the whole procedure.
- Since this procedure is performed sterilely, no antibiotics is needed for this surgery.
- Make sure your identity has been confirmed with name and date of birth
- Make sure your procedure has been confirmed
- Make sure the correct site of your surgery has been marked
- Make sure the correct side of your surgery has been marked
- Confirm any allergies and side-effects you might have
- Make sure you understand and have signed the informed consent forms
- Unless your surgeon specifically says otherwise, your surgery went according to plan without complications.
- With the exception of blood thinners, most prescription drugs do not need to be stopped and can be continued throughout the day of the procedure. Blood thinners can be restarted after surgery.
- There is no restrictions to eating or drinking prior to or after surgery.
- If you experience and post-operative pain, you should take some over the counter pain medications such as acetaminophen (Tylenol) or Ibuprofen (Advil/Motrin).
- After 24-48hrs, you can remove all the dressing around your surgical site. You can wash your hand like normal, allowing soap and water to run over the incision site. Please do not rub the incision as the stitches can come apart. Polysporin can be applied to the surgical site. No bandages are needed to cover the area after 48hrs.
- If the ganglion cyst is at the wrist, you should rest your hand for 1 week prior to physical therapy and exercises. If the cyst was in the fingers/toes, you can use your affected hand/foot immediately after surgery.
- You should return for a follow up appointment approximately 10-14 days after surgery for suture removal.
- Sutures are removed 10-14 days after your surgery. We will set up a date for you to return to have that done.
- With the exception of intense sports, you can resume your normal activity after surgery. Please wear a removable splint to protect the surgery site if your ganglion cyst was located in the wrist area.
- There is no restrictions to sexual activity before/after surgery.
- You can return to work the following day after surgery. You can resume work while wearing the removable splint if the ganglion cyst was at the wrist.
- There is no restrictions to driving after surgery.
- Make sure your care providers wash their hands before and after your care
- Do not wait until your pain is severe before you ask for pain medication
- Sit on the edge of the bed for a few minutes before you stand up to prevent getting dizzy
- Do not get out of bed without help if you feel weak or dizzy
- You have a fever higher than 100.4 degrees Fahrenheit
- You have shortness of breath or chest pain
- You notice increased redness, swelling, warmth, or pain around your surgical incision
- You notice that your incision is separating or you have infected discharge from your incision
- Your dressing is repeatedly soaked with blood
- You experience weakness, numbness/tingling, or a coolness in your affected hand or foot
- You have pain that your existing pain medications cannot control
- Take pain and other medications as prescribed
- Do not drive when you are on prescription pain medications
- Do not soak in a bath or go swimming for ten days after your surgery
- Keep your incision clean and dry
- Keep your affected hand or foot elevated to reduce swelling
- Avoid strenuous exercise and heavy lifting as long as your doctor advises
- Follow your doctor’s instructions on resuming normal daily activities
- Follow your doctor’s instructions on resuming sexual activity
- A ganglion cyst is a benign fluid filled sack typically found in the hands/wrist area but has been seen over almost all joints of the body. This sack is typically filled synovial fluid which is a gel like fluid that is found in joint spaces.
- Typically, there are two ways to treat a cyst. If these sacs are managed earlier, the fluid in the sac isn’t too thick and can be aspirated from the sac using a large size needle. However, sometimes depending on location or the consistency of the fluid, you may need a surgical excision of the sac.
- Although these cysts are benign, sometimes if it is located at an area where is frequent contact with other surfaces causing irritation and discomfort. In the distant past, people have use large books, such as the bible, to forcibly burst these cysts. Giving ganglion cyst the nick name of “bible cyst”. Although this is one method of dealing with the cyst, it is not recommended as it can often cause injury to other areas and there are other tumours that can mimic ganglion cyst.
- There are different factors that helps determine whether the cyst should be removed surgically or simply aspirated with a needle.
The size of the cyst and location of the cyst may make it harder/easier to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration
The consistency of the fluid in the cyst. Sometimes the fluid can be thickened and make it hard to aspirate/express the fluid from the sac.
There are higher rates or recurrence when the cyst is aspirated as the lining of the cyst is not remove when it is aspirated opposed to surgical excision which usually removes the cyst intact.
- The most commonly accepted cause of ganglion cysts is the herniated hypothesis where it is thought that cysts arise from weakening of the joint capsule/tendon sheath based on the idea that these cysts are often found along joint spaces/tendinous sheaths and the fluid found in these cavities are often similar to fluid found in joint spaces.
The size of the cyst and location of the cyst may make it harder/easier to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration
The consistency of the fluid in the cyst. Sometimes the fluid can be thickened and make it hard to aspirate/express the fluid from the sac.
There are higher rates or recurrence when the cyst is aspirated as the lining of the cyst is not remove when it is aspirated opposed to surgical excision which usually removes the cyst intact.
- If the ganglion cyst is at the wrist, you should rest your hand for 1 week before starting any physical therapy or activity. Please protect with wrist with a removable splint. You should avoid swimming or tub bathing until your incision is completely healed (10-14days) and sutures are removed from the incision site
The size of the cyst and location of the cyst may make it harder/easier to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration
The consistency of the fluid in the cyst. Sometimes the fluid can be thickened and make it hard to aspirate/express the fluid from the sac.
There are higher rates or recurrence when the cyst is aspirated as the lining of the cyst is not remove when it is aspirated opposed to surgical excision which usually removes the cyst intact.
Hair loss usually follow your genetic course unless it is altered by medicine (i.e. propecia) and / or surgery
I do both FUE and FUT technique.
With FUE and FUT, the transplantation is usually the same but the extraction methods are different.
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