Ganglion Cysts Can Be Easily Removed

Dr. Keith Segalman Union Memorial Hospital

August 10, 2009

A ganglion cyst is an abnormal growth or mass adjacent to any joint in the body. It is most commonly seen around the wrist or digits, but can develop near the shoulder, knee or foot. Depending on the location of the cyst, various names have been used to describe the mass. A ganglion adjacent to the nail of the finger is called a mucous cyst, and one behind the knee is called a Baker's cyst.

Dr. Keith Segalman, hand surgeon at the Curtis National Hand Center at Union Memorial Hospital in Baltimore, discusses what to do about this kind of inflammation:

* A ganglion cyst is the most common tumor or growth that occurs in the hand and wrist. It is a benign lesion, and the most common location is on the back side of the wrist. A ganglion arises because of inflammation within the joint. Inflammation can arise from overuse, arthritis or underlying medical conditions. Ganglions can be confused with aneurysms of the artery in the wrist, chronic infections or very rarely a cancerous process.

* Adolescents are the most common patients with a ganglion cyst, but they can be seen in patients of all ages. Patients with ganglion cysts typically have only one lesion, but some people seem to be predisposed to having them in multiple locations. Patients may describe increasing stress on the individual joint prior to the onset of symptoms, such as weight lifting, push ups or gardening, but for most people we never know the cause.

* The patient will notice a mass, growth or "knot." The mass typically will vary in size and can cause some discomfort but rarely causes true pain. There may be some stiffness in the involved joint and rarely some numbness in the hand if the ganglion is in the wrist. Most of the time, an X-ray is taken to ensure that the ganglion is not arising from some underlying joint problem such as arthritis or a ligament tear.

* Treatment for ganglions ranges from splinting to aspiration and injection to surgical removal. Since most ganglions arise from overuse of the joint, resting the joint with a protective splint will allow the mass to resolve. For a wrist ganglion, splinting in a "cock-up" wrist splint at night will relieve the symptoms.

If the symptoms do not improve, the ganglion can be aspirated. Aspirations are helpful to confirm the diagnosis and relieve the symptoms, but the ganglion will recur if the patient doesn't modify the activity that causes the symptoms.

The indications for removal include recurrence, enlarging size and progressive pain. The procedure is done as an outpatient under general or regional anesthesia. Usually, the wrist is splinted for about 10 days and then motion is begun. Depending on the location of the cyst, recovery can take four to six weeks.

* If the ganglion is removed, the recurrence rate is about 5 percent. The biggest reason for the ganglion to recur is that the surgeon does not use adequate anesthesia to allow him or her to dissect down to the capsule or "root." For this reason, ganglions should be removed only by those trained in the area of the body in which they arise. Other complications include persistent stiffness in the joint. Because of the stiffness, many patients will require therapy after surgery. Rarely seen complications include infection, pain, some numbness around the incision and arterial injury.

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