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Complex ganglion cyst: Ganglion cyst – Diagnosis and treatment

by alexxlab

Cysts – ganglion cysts – Better Health Channel

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Summary

Read the full fact sheet

  • A ganglion cyst is a benign ball of fluid that grows on a tendon or joint.
  • The backs of the hands and wrists are most commonly affected, but ganglion cysts can also grow on the feet, knees and ankles.
  • The cause is unknown, but it is thought that small tears in the tendon membrane or joint capsule allow the contents to squeeze out.
  • In many cases, ganglion cysts go away by themselves without the need for medical treatment.
  • Treatment options include surgery or draining the cyst with a needle.

A tendon is a tough band of connective tissue that joins muscle to bone. Tendons and joints have a covering of membrane that produces a lubricating fluid to assist their function. A ganglion cyst is a benign (non-cancerous) ball of fluid that grows on the membrane or sheath that covers these tendons and joints. The backs of the hands and wrists are most commonly affected, but ganglion cysts can sometimes grow on the feet, knees and ankles. A ganglion cyst is the most common lump on the hand, and tends to target women between the ages of 20 and 40 years of age, for reasons unknown.

As tendons anchor muscle to bone, a ganglion cyst on a tendon may cause muscle weakness. Depending on the individual, there may be just one large lump or a collection of many smaller ones attached to a single ‘stalk’ deeper in the tissue. Around one third to one half of ganglion cysts disappear on their own without the need for medical treatment. However, it is best to consult your doctor to make sure the swelling is not a symptom of some other type of illness.

Symptoms of ganglion cysts

The symptoms of a ganglion cyst include:

  • Noticeable swelling or lump.
  • The lump is able to change its size, including going away completely only to return.
  • The lump is usually soft and immobile.
  • In some cases, the lump is painful and aching, particularly those at the base of fingers.
  • The ache and pain is made worse by moving any nearby joints.
  • The affected tendon may cause a sensation of muscular weakness.
  • The back of the hands and wrists are most commonly affected.
  • Other sites include the back of the knee (Bakers cyst), ankle, foot, palm and fingers.

Causes of ganglion cysts

No one knows what causes a ganglion cyst to form. Some of the theories include:

  • The body responds to injury, trauma or overuse by forming an internal ‘blister’.
  • Small tears in the tendon membrane or joint capsule allow the contents to squeeze out.

Ganglion cysts can disappear

Around 30 to 50 per cent of ganglion cysts disappear by themselves without the need for medical treatment. However, it is always best to consult your doctor 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, see your doctor.

Diagnosis of ganglion cysts

Ganglion cysts are diagnosed using a number of tests including:

  • Medical history
  • Physical examination
  • Ultrasound
  • X-rays
  • Needle aspiration (a fine needle is used to draw off fluid, which is then examined in a laboratory).

Treatment for ganglion cysts

Ganglion cysts used to be treated by slamming them with a heavy book such as a Bible – which explains the term ‘Bible therapy’. This isn’t a good idea, as you could cause further injury. Medical treatment options include:

  • Close monitoring – if the ganglion cyst isn’t causing pain or interfering with movement, some doctors prefer to wait and see. The cyst may simply disappear on its own.
  • Needle aspiration – one of the tests to diagnose ganglion cysts involves drawing off the fluid with a fine needle. In many cases (around 75 per cent), this treatment empties the cyst and no further action is needed.
  • Surgery – the cyst or cysts are surgically removed, usually by a specialist such as an orthopaedic surgeon. Ganglion cysts of the feet will usually require surgery.

Joint mobility after treatment

Whether your ganglion cyst is aspirated or surgically removed, you will be fitted with a splint for around one week or so. Depending on the location of the excised ganglion cyst, full recovery can be anywhere from two to eight weeks. Be guided by your doctor or health care professional, but generally it is best to get the joint moving again as soon as possible. Using splints for extended periods of time can actually hamper joint mobility. Your doctor will give you specific exercises to perform.

Ganglion cysts may return

Ganglion cysts may grow back after treatment. This is less likely if your cysts were surgically removed rather than aspirated with a needle. Some estimates suggest that around half of patients who undergo needle aspiration can expect a recurrence. Since the cause of ganglion cysts is unknown, prevention is impossible. If you suspect your ganglion cyst is recurring, see your doctor for further treatment. A ganglion cyst that is aspirated three times has a better than 80 per cent chance of being cured.

Where to get help

  • Your doctor
  • Orthopaedic surgeon

Things to remember

  • A ganglion cyst is a benign ball of fluid that grows on a tendon or joint.
  • The backs of the hands and wrists are most commonly affected, but ganglion cysts can also grow on the feet, knees and ankles.
  • The cause is unknown, but it is thought that small tears in the tendon membrane or joint capsule allow the contents to squeeze out.
  • In many cases, ganglion cysts go away by themselves without the need for medical treatment.
  • Treatment options include surgery or draining the cyst with a needle.

  • Pattison, Dr A., ‘Finding a lump – some types’, in Common Consultations [online book], North East Valley Division of General Practice, Victoria, Australia. More information hereExternal Link.
  • Ganglion cyst (2000) [online article], Indiana Hand Centre, MANUS, USA. More information hereExternal Link.

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Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 21-08-2014

Ganglia of the hand and wrist: a sonographic analysis

Meta-Analysis

. 2008 Sep;191(3):716-20.

doi: 10.2214/AJR.07.3438.

Sharlene A Teefey 
1
, Nirvikar Dahiya, William D Middleton, Richard H Gelberman, Martin I Boyer

Affiliations

Affiliation

  • 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd. , St. Louis, MO 63110, USA. [email protected]

  • PMID:

    18716098

  • DOI:

    10.2214/AJR.07.3438

Meta-Analysis

Sharlene A Teefey et al.

AJR Am J Roentgenol.

2008 Sep.

. 2008 Sep;191(3):716-20.

doi: 10.2214/AJR.07.3438.

Authors

Sharlene A Teefey 
1
, Nirvikar Dahiya, William D Middleton, Richard H Gelberman, Martin I Boyer

Affiliation

  • 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd. , St. Louis, MO 63110, USA. [email protected]

  • PMID:

    18716098

  • DOI:

    10.2214/AJR.07.3438

Abstract


Objective:

The purpose of this study was to analyze the sonographic appearance of a large series of pathologically proven ganglia.


Materials and methods:

A computer search of sonography and pathology reports for hand and wrist ganglia was performed. All sonography reports and images were reviewed for ganglion size, location, presence of a neck, echogenicity, acoustic enhancement, locules, color Doppler flow, margins, wall thickness, and calcifications and to determine if the ganglion was palpable or collapsed. All pathology reports were reviewed for histologic features that were then correlated with the sonographic images. Ganglia were categorized into three groups: simple, complex cystic, and solid-appearing.


Results:

Of 60 ganglia, 34 were complex, 91% of which were located within the dorsal or volar wrist; 97% had well-defined margins; 76%, locules; 68%, acoustic enhancement; 47%, a thick wall; 15%, internal reflectors; and 12%, blood flow. Of the 23 simple ganglia, 11 involved the extensor or flexor tendon sheath, 73% of which were simple. Complex ganglia had a larger mean volume than simple. Three ganglia were solid-appearing. A visible neck was seen in 25% of ganglia.


Conclusion:

Most ganglia are complex rather than simple on sonography. Complex ganglia are larger than simple ganglia; located within the dorsal or volar wrist; and usually have well-defined margins, thick walls, locules, and acoustic enhancement. A small percentage have blood flow and internal reflectors. Simple ganglia are smaller and can occur within the volar or dorsal wrist, or flexor tendon sheath. Most flexor tendon sheath ganglia are simple rather than complex. Solid-appearing ganglia, although unusual, may mimic a benign neoplasm or synovitis.

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MeSH terms

What you need to know about cysts – LIFEKOREA.ru

Cysts are closed capsular or sac-like structures, usually filled with liquid, semi-solid or gaseous material, much like a blister.

Cysts vary in size from microscopic to very large. Very large cysts can dislodge internal organs. Most are benign, but some cysts may be malignant or precancerous.

The cyst is not a normal part of the tissue where it is located. It has a distinct membrane and is separated from adjacent tissue. The outer (capsular) part of the cyst is called the cyst wall.

This article discusses the different types of cysts, their causes and symptoms, and some treatment options.

What causes cysts?

Cysts are quite common and can occur anywhere on the body. They are often the result of infection, clogged sebaceous glands, or piercings.

Some other common causes of cysts include:

  • tumors
  • genetic conditions
  • defect in an organ of a developing fetus
  • cell defect
  • chronic inflammatory diseases
  • blockage of ducts in the body that cause fluid accumulation
  • parasites
  • injury that breaks the vessel

In most cases, cysts often cause pain, even if they do not rupture, become infected, or become inflamed.

Benign and malignant cysts

Most cysts are benign and develop due to a blockage in the body’s natural drainage systems.

However, some cysts may be tumors that form inside tumors. They may be malignant or cancerous.

Cysts are different from tumors.

Cyst symptoms

Signs and symptoms will vary widely depending on the type of cyst. In many cases, the person is first aware of the abnormal swelling, especially when the cyst is under the skin.

Many internal cysts, such as those in the kidneys or liver, may cause no symptoms at all. They may go unnoticed until an imaging scan such as an MRI, CT, or ultrasound finds them.

If a cyst develops on the brain, it may cause headache and other symptoms. Breast cysts can also cause pain.

Types of cysts

Some of the more common types of cysts include:

Acne cysts in which the pores of the skin are blocked, leading to infection and inflammation.

Arachnoid cysts

Arachnoid cysts can affect newborns.

The arachnoid membrane covers the brain. During fetal development, it doubles or splits, forming an abnormal pocket of cerebrospinal fluid. In some cases, the doctor may need to drain the cyst.

Baker’s cysts

Baker’s cysts are also called popliteal cysts. A person with a Baker’s cyst often experiences a bulge and a feeling of tightness behind the knee. The pain may increase with knee extension or with physical activity.

Baker’s cysts usually develop due to problems with the knee joint, such as arthritis or a cartilage tear.

Bartholin’s cysts

Bartholin’s cysts can occur when the ducts of the Bartholin’s gland, which are inside the vagina, become blocked.

Your doctor may recommend surgery or prescribe antibiotics.

Breast cysts

Breast cysts are common and can be painful, but they usually do not require any treatment.

In women, these cysts may develop or change in size during the menstrual cycle and often disappear on their own. However, the doctor may drain the fluid if they cause discomfort.

According to the American Cancer Society, simple cysts do not increase the risk of breast cancer. However, there is a small chance that complex cysts may contain cancer cells or increase the risk of cancer in the future.

Chalazion cysts

Very small glands in the eyelids, called meibomian glands, produce a lubricant that comes out of tiny holes at the edges of the eyelids. Cysts can form here if the ducts are blocked. They are known as chalazion cysts.

Colloidal cysts

Colloidal cysts develop in the brain and contain gelatinous material. Doctors often recommend surgical removal as a treatment.

Dental cysts

Dental cysts surround the crown of an undeveloped tooth.

Dermoid cysts

Dermoid cysts include mature skin, hair follicles, sweat glands, and long hair tufts, as well as fat, bone, cartilage, and thyroid tissue.

Epididymal cysts

Epididymal cysts or spermatoceles form in the vessels attached to the testicles. This type of cyst is common and usually does not impair fertility or require treatment. However, if it causes discomfort, the doctor may suggest surgery.

Ganglion cysts

Ganglion cysts are small, harmless cysts that form on or near a joint or tendon covering. They usually develop on the wrist but can also appear on the arm, leg, ankle, or knee.

Hydatid cysts

Hydatid cysts develop from a relatively small tapeworm. These cysts form in the lungs or liver. Treatment options include surgery and medication.

Renal cysts

There are several types of renal cysts. Solitary cysts contain fluid, sometimes including blood. Some are present at birth, while tubular blockages are caused by others.

People with kidney vascular disease may have cysts that form due to dilation of blood vessels.

Ovarian cysts

Ovarian cysts are common in menstruating women. They are formed during ovulation.

Most ovarian cysts are benign and cause no symptoms. However, some may become so large that the abdomen bulges out.

Polycystic ovary syndrome causes many small cysts to develop in the ovaries.

Pancreatic cysts

Most healthcare professionals do not consider pancreatic cysts to be true cysts. Instead, they call them “pseudocysts” because they do not contain the cell types found in true cysts.

These may include cells normally found in other organs such as the stomach or intestines.

Periapical cysts

Periapical cysts, also known as radicular cysts, are the most common type of odontogenic cyst associated with the formation and development of teeth. These cysts usually develop due to pulp inflammation, pulp death, or tooth decay.

Pilar cysts

Pilar cysts are also known as trichilem cysts. They are fluid-filled cysts that form from the hair follicle and usually develop in the scalp.

Pilonidal cysts

Pilonidal cysts form in the skin near the coccyx or lower back and sometimes contain ingrown hairs.

These cysts can grow in clusters, sometimes creating a hole or cavity in the skin.

Pineal cysts

These are benign cysts that form in the pineal gland in the brain. According to a 2007 study, pineal cysts are quite common.

Sebaceous cysts

People use the term sebaceous cyst to describe a type of cyst that occurs on the face, back, scalp, or scrotum.

Cysts that occur in these areas may be epidermoid or pilar cysts, although health professionals can tell the difference only after the cyst is removed and analyzed.

Tarlov cysts

Tarlov cysts, also known as perineural cysts, are perineural or sacral cysts of the nerve root located at the base of the spine and filled with cerebrospinal fluid.

Vocal cord cysts

There are two types of vocal cord cysts: mucus retention cysts and epidermoid cysts.

Vocal cord cysts can affect a person’s speech quality, sometimes damaging their vocal cords:

  • several tones at the same time, called dipphonia
  • respiratory speech or dysphonia
  • hoarseness

Cyst Treatment

Treatment options for a cyst will depend on a number of factors, including the type of cyst, where it is located, its size, and how much discomfort it causes.

For very large cysts that cause symptoms, your doctor may recommend surgical removal.

Sometimes a doctor may drain or aspirate a cyst by inserting a needle or catheter into the cavity. If the cyst is not easily accessible, doctors may use the x-ray image to accurately guide the needle or catheter.

Sometimes a healthcare provider may examine the removed fluid under a microscope to determine if any cancer cells are present. If he suspects the cyst is cancerous, he may suggest surgical removal, order a biopsy of the cyst wall, or both.

Many cysts develop as a result of a chronic or underlying disease, such as fibrocystic breast disease or polycystic ovary syndrome. In such cases, treatment will focus on the disease itself rather than the cyst.

Summary

Cysts are abnormal, fluid-filled sacs that can develop in tissues anywhere in the body. They are relatively common and there are many different types.

Cysts can be caused by infections, tumors, parasites, and trauma. These cysts are usually cancer-free.

If a person is worried about a cyst or notices a new tumor, they should see a doctor for an accurate diagnosis and treatment if necessary.

Pain in the hand | Bodro Clinic

Pain in the hand or finger at Bodro Clinic.

Wrist pain is usually caused by sprains or fractures from sudden injuries

But hand pain can also be the result of long-term health problems such as injuries from repetitive deformities, arthritis, and carpal tunnel syndrome.

It is sometimes quite difficult to make an accurate diagnosis of why the hand hurts due to the abundance of risk factors, but it is necessary to establish a clear cause for concern for proper treatment and recovery.

Our doctors

Kryzhanovsky Sergey Anatolyevich

Surgeon

More about the doctor

Shopuk Viktor Nikolaevich

Orthopedist-traumatologist

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Symptoms

Pain in the hand is always different in sensations and depends on the form of the disease. For example, osteoarthritis pain usually feels like a dull toothache, and carpal tunnel pain feels like “pins and needles,” especially at night. The exact localization and nature of the pain will help the doctor determine its cause.

When to see a doctor?

Not every case of hand pain requires medical attention. Mild sprains respond well to physical therapy, in particular cryotherapy, sedation, and over-the-counter pain relievers. But if the pain and swelling increase, be sure to consult a doctor. Delaying examination and diagnosis can lead to limited hand function, pain, and ineffective treatment.

Causes

Damage to any part of the hand will cause pain and affect the function of the wrist and hand.

Traumatic injuries:

  • Sudden injuries . Usually, this is a fall on an outstretched hand, which leads to overstrain, sprains and even fractures that are difficult to diagnose by x-rays. That is why we often perform more complex and effective diagnostic procedures (MRI of the hand or ultrasound of the hand)
  • Chronic overload injury . Any activity that involves cycling your wrist – from throwing a tennis ball to playing the cello or even driving – can lead to inflammation of the tissues around your joints or even fractures, especially if you repeat the movement of your wrist for hours without a break. De Quervain’s disease or syndrome is a deformity injury that causes pain at the base of the first (thumb) toe.

Arthritis:

  • Osteoarthritis . This is a type of arthritis where the cartilage that covers the ends of your bones breaks down over time. Osteoarthritis of the wrist and hand is rare, and usually occurs only in people with a history of hand injury.
  • Rheumatoid arthritis . This is a type of pathology when the body’s immune system attacks its own tissues; and rheumatoid arthritis often affects the wrists and hands. If one hand is affected, the other will also be affected.

Other conditions and pathologies

  • Carpal tunnel syndrome . This pathology develops with an increase in pressure on the median nerve at the site of its passage through the carpal tunnel on the palmar side of the hand.
  • Ganglion cysts . These types of soft tissue cysts are formed on the back of the hand, can be painful and the pain will increase during the load on the limb.
  • Kienböck’s disease . For an unknown reason, the blood supply to the lunate bone is disrupted and its osteonecrosis develops.

Risk factors

Risk increases with:

  • Active sports , especially those that have repetitive wrist and hand motions – football, golf, bowling, gymnastics, snowboarding and tennis
  • Work that uses constant repetitive motion – any activity that uses the wrist extensively – even knitting or cutting hair
  • Certain diseases and conditions – pregnancy, diabetes, obesity, rheumatoid arthritis, etc.

Necessary diagnostics for correct diagnosis?

  • First of all, you will be consulted by an orthopedic traumatologist specializing in diseases of the hand
  • If needed – Ultrasound, MRI, x-ray, joint tap, nerve block, or other additional tests to make an accurate diagnosis
  • If necessary – consultation of related specialists – rheumatologist, surgeon, neuropathologist and tests, if required.