What is a ganglion cyst?
Ganglion cysts are fluid filled sacks that arise from either tendons or joints. The most common types of ganglions in the hand and wrist are dorsal carpal ganglions on the back of the wrist, volar carpal ganglions on the front of the wrist, mucous cysts on the back of the finger joints and ganglions of tendon sheaths on the front of the fingers.
How do ganglion cysts occur?
A ganglion consists of normal joint or tendon fluid that has escaped through a weak point in the joint or tendon sheath. They are completely benign and do not spread to other parts of the body. Ganglions can be painful when they put pressure on a nerve or tendon. Aside from the mechanical pain of pressure on the ganglion, they can cause acing and soreness with activity. Occult ganglions are so small that they cannot be seen under the skin and can be a cause of wrist pain. They can occur from trauma such as a fall or car accident. They can occur from repetitive use activities. Often, no specific cause is established. Patients often thing ganglions are a sign of arthritis. Although that can occur, on most occasions, they are not related to arthritis.
Diagnosing ganglion cysts
Ganglions are diagnosed by direct visualization or by MRI. X-rays are often done to look for signs of arthritis. Ganglions can appear hard even though they are fluid filled. A good analogy it to think about a water ballon. They appear hard but are simply water under pressure. Ganglion cysts need to be distinguished from other growths that may occur. Growths such as a giant cell tumor, inclusion cysts and many other can have the same appearance as a ganglion cyst. This is why advanced imaging such as MRI may be necessary. Dr. Kavi Sachar will evaluate you and determinate if advanced imaging modalities are necessary.
Nonsurgical treatment of ganglion cysts
If ganglions are asymptomatic, they can be observed. They are not harmful. If painful, non-surgical treatment usually consists of aspiration with a needle . In aspiration, a needle is placed in the ganglion to draw off the fluid. Some ganglions cannot be aspirated based on location and size. The ganglion can come back after aspiration because there is a stalk that goes down to the joint and helps feed the ganglion fluid. The success rate of aspiration is about 50%. Therapy is usually not helpful in the treatment of ganglion cysts.
Surgical treatment of ganglion cysts
Ganglions are often excised surgically. Surgery is an outpatient procedure. Either a regional or light general anesthetic is used. An incision is made over the ganglion and it is traced down to the stalk. It is cauterized at the stalk to minimize the risk of a new one forming. The area is inspected to look for signs of arthritis or other abnormalities. Invisible sutures are often used to close the wound.
Recovering from ganglion surgery
Post surgical treatment varies depending on the location of the ganglion. If the wrist is involved, it is immobilized for a few days and therapy is started to regain motion and strength. If it is in the finger, a soft dressing is used. Therapy may be needed to regain motion, for strength and for scar management. Most patients are back to normal activities within 3 weeks. New ganglions can occur in the same location where there were removed from. The chance of this happening is very low, about 5-10%.
Schedule a consultation
Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on ganglion cysts. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from a ganglion cyst, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.
At a Glance
Dr. Kavi Sachar
- Specializing in Hand, Wrist, & Elbow Surgery
- Board Certified Orthopedic & Hand Surgeon
- Consultant to the US Ski & Snowboard Team & Colorado Avalanche
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