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Symptoms, Causes, Diagnosis, and Treatment
What Is a Ganglion Cyst?
A ganglion cyst is a small sac of fluid that forms over a joint or tendon (tissue that connects muscle to bone). Inside the cyst is a thick, sticky, clear, colorless, jellylike material. Depending on the size, cysts may feel firm or spongy.
Ganglion cysts, also known as bible cysts, most commonly show up on the back of the hand at the wrist joint but they can also develop on the palm side of the wrist. They can also show up in other areas, but these are less common:
- The base of the fingers on the palm, where they appear as small pea-sized bumps
- The fingertip, just below the cuticle, where they are called mucous cysts
- The outside of the knee and ankle
- The top of the foot
Ganglion Cyst Symptoms
Symptoms of a ganglion cyst can include:
- A soft bump or mass that changes size but doesn’t move.
- Swelling that may appear over time or suddenly.
- It may get smaller in size or even go away and come back.
- One large cyst or many smaller ones may develop, but they are usually connected by deeper tissue.
- Some degree of pain is possible, especially after acute or repetitive trauma, but many aren’t painful.
- Pain may be chronic and get worse with joint movement.
- When the cyst is connected to a tendon, you may feel a sense of weakness in the affected finger.
The below image shows a traumatic ganglion cyst. This person came to the emergency department with a painful bump after the wrist was hit by a car door.
The image below shows the jellylike fluid taken from the cyst in the above image. Its presence confirms the diagnosis of a ganglion cyst.
An ultrasound image below shows the ganglion cyst (area between markers).
The below image shows a ganglion cyst that has been operated on in the past. This ganglion returned because this person plays the cymbals in their school band.
Ganglion Cyst Causes and Risk Factors
The cause of ganglion cysts is not known. One theory suggests that trauma causes the tissue of the joint to break down, forming small cysts that then join into a larger, more obvious mass. The most likely theory involves a flaw in the joint capsule or tendon sheath that allows the joint tissue to bulge out.
Ganglion cysts are more common in women, and 70% occur in people between the ages of 20-40. Rarely, ganglion cysts can occur in children younger than 10 years.
Ganglion Cyst Diagnosis
If you have a bump, you should see your doctor, even if you don’t have symptoms that bother you. A physical exam is often all that is needed to diagnose a ganglion cyst.
- Your doctor may get further confirmation by using a syringe to draw out some of the fluid in the cyst (needle aspiration) or by using ultrasound. An ultrasound picture is made as sound waves bounce off of different tissues. It can determine whether the bump is fluid-filled (cystic) or if it is solid. Ultrasound can also detect whether there is an artery or blood vessel causing the lump.
- Your doctor may send you to a hand surgeon if the bump is large or solid or involves a blood vessel (artery).
- MRI is used to see the wrist and is very useful for ganglions. One drawback to this diagnostic method is the cost of the procedure.
Ganglion Cyst Treatment
A ganglion cyst doesn’t need emergency treatment unless you have significant trauma. A routine check by either your doctor or a specialist in bones and joints (an orthopedist) is often enough.
Self-care at home
If your cyst isn’t bothering you, your doctor may tell you to keep an eye on it and be in touch if anything changes. Many cysts can disappear without any treatment at all.
In the past, home care for these growths included topical plaster, heat, and various poultices. It even extended to use of a heavy book to physically smash the cyst. These forms of treatment are no longer suggested, because they have not been shown to keep the ganglion cysts from returning and could, in fact, cause further injury.
If your cyst is bothering you, your doctor may recommend one of these treatments:
- Aspiration: With this procedure, a needle is placed into the cyst to draw the liquid material out. Then a steroid compound (anti-inflammatory) is injected into the area and the area is put in a splint to keep it from moving. Aspiration doesn’t remove the area that attaches the cyst to the joint, so they often return.
- Surgery: With this procedure, the doctor removes the cyst and the area around it that attaches it to the joint. Your doctor may recommend surgery if aspiration hasn’t helped and the mass is painful, it interferes with function (especially when your dominant hand is involved), or it causes numbness or tingling of the hand or fingers.
Next Steps Follow-Up
After you have been diagnosed with a ganglion cyst and have chosen to have treatment, follow-up will be different based on what you have chosen to do.
- After simple aspiration, your doctor may ask you to start moving the joint soon after the procedure.
- Most likely after surgery, your joint will be splinted for up to 7 to 10 days. A splint is a hard wrap that will keep you from moving your joint.
- Studies show that splinting for a long period of time doesn’t really help, so you may be encouraged to use the joint soon afterward.
- Your doctor may ask you to return for a checkup after your surgery and will decide if physical or occupational therapy is needed. Follow-up care will be based on your personal needs.
Ganglion Cyst Prevention
Because the cause of a ganglion cyst is not known, it is difficult to tell how to prevent them. Early evaluation and treatment are recommended.
Ganglion Cyst Outlook
Because this is a tumor that can go away on its own, or after a simple needle aspiration or minor surgery, chances are good that you will have a full recovery. Because ganglion cysts may come back after any of these treatments, however, a single treatment may not be enough.
Ganglion Cysts (for Parents) – Nemours Kidshealth
What Are Ganglion Cysts?
Ganglion cysts are lumps that, most commonly, develop on the back of the wrist. Underneath the skin is a fluid-filled sac.
Although they’re known medically as soft tissue tumors, ganglion (GAN-glee-in) cysts are not cancerous and are easily treated.
What Causes Ganglion Cysts?
Doctors don’t know exactly what causes ganglion cysts.
Who Gets Ganglion Cysts?
Ganglion cysts are most common in people 15 to 40 years old, especially girls and women. But people of any age can have a ganglion cyst.
Some ganglion cysts are associated with arthritis.
How Do Ganglion Cysts Develop?
Moving parts have lubrication fluid — in a car, for instance, the engine has motor oil. In the body, joints and tendon sheathes (space around tendons) make synovial fluid (a thick lubrication fluid). This fluid is supposed to stay in the joint or in the tendon sheathe.
A ganglion cyst forms when the joint or tendon sheathe has a “leak.” This leak develops a thin wall around it and forms a cyst under the skin.
If you could look beneath the skin to see a ganglion cyst, it would resemble a water balloon (the cyst) attached to a faucet (the joint or the tendon).
What Are the Signs & Symptoms of a Ganglion Cyst?
The distinctive lumps are the main sign of ganglion cysts. Most are round or oval. They might change size, growing larger or smaller as more fluid leaks in or gets absorbed. Most ganglion cysts are not painful. Occasionally a cyst may cause a dull ache or pain if it is “squeezed.” For example, a cyst on the top of a person’s wrist may cause pain when he or she does a push-up.
While most ganglion cysts are on the back of the hand or wrist, they sometimes can form on the palm side of the wrist, the base of the finger on the palm side, and the top of the feet.
How Are Ganglion Cysts Diagnosed?
Doctors usually can diagnose a ganglion cyst based on where it is and how it looks and feels. The cyst can be soft or firm.
Ganglion cysts usually will transilluminate (let light through) in an office test using a small light. They also can be easily viewed with an ultrasound.
How Are Ganglion Cysts Treated?
Many ganglion cysts go away without medical treatment. Doctors often decide to “watch and wait” to see if a cyst goes away or doesn’t get worse, especially if it’s not painful. Up to 90% of ganglion cysts in young children will go away on their own within 1 year.
If repetitive movements make the cyst bigger or more painful, the doctor may recommend rest and wearing a splint or brace. Anti-inflammatory medicines can help ease minor pain or discomfort.
Note: You might have heard a ganglion cyst called a “Bible cyst” or “Bible bump.” That’s because a common home remedy in the past was hitting the cyst with a Bible or other thick book to try to make the cyst rupture or pop. Doctors don’t recommend this treatment, but occasionally a cyst will rupture if a child falls on it. If this happens, the area will be red, swollen, and sore for a few days. Just like a ruptured water balloon, the cyst may not come back.
If a cyst is bothersome, painful, or long-lasting, a doctor might “aspirate” (or drain) it with a long needle. In this quick and effective office procedure, a doctor will:
- Numb the area around the ganglion cyst.
- Puncture the cyst with a needle, then withdraw the fluid.
Even with aspiration, a ganglion cyst may come back. That’s because aspiration only removes the fluid in the cyst. It doesn’t remove the cyst or its connection to the source of the fluid. (It takes the fluid out of the “water balloon,” which is still connected to the “faucet.”)
In some cases, a doctor might recommend a minor surgery to remove a ganglion cyst. The surgical procedure — called a ganglion excision, or ganglionectomy — removes the ganglion cyst along with the stalk. This is outpatient surgery (doesn’t require a hospital stay) and is usually done with general anesthesia.
Home Care After an Excision
If your child has an excision, the area will be covered with a dressing or bandages and usually a splint or cast.
The surgical site might be tender and swollen. Keeping the hand raised above the level of the heart for a few days can help ease swelling. For pain, ask your health care provider about giving your child ibuprofen or acetaminophen. An ice pack wrapped in a towel also can help with pain and swelling. Keep the bandages and splint dry, covering them with a waterproof bag when your child bathes or showers.
At a follow-up visit, the health care provider might recommend physical therapy or occupational therapy to help your child’s recovery. Most kids can return to normal activities 2–4 weeks after the surgery.
Wrist Ganglion Cyst – Lump on the Back of the Hand
A wrist ganglion cyst is a swelling that usually occurs around the hand or wrist. A ganglion cyst is a fluid-filled capsule; they are not cancerous, will not spread, and while they may grow in size, they will not spread to other parts of your body. Ganglion cysts can occur on the back of the hand or on the palm side of the wrist. When they occur on the back of the hand, they are called a dorsal ganglion cyst. When they occur on the palm side of the wrist they are called volar ganglion cysts.
Ganglion cysts are in fact not even “true cysts,” but rather arise as pouches of fluid that comes from the small joints of the wrist, or from the fluid within the sheath that surrounds the wrist tendons. When the fluid, called synovial fluid, leaks out from these spaces, it can form a sack-like structure that we call a ganglion cyst. The fluid within the ganglion cyst is identical to the normal fluid found within a joint or within a tendon sheath. The fluid is gelatinous and looks and feels like jelly.
It is important to have this type of lump checked by your doctor to ensure it is simply a ganglion cyst.
While most lumps and bumps of the hand and wrist are ganglion cysts (by far the most common), there are other conditions that have different treatments. Other types of tumors such as a lipoma or giant cell tumor, infections, carpal bossing (bone spur), and other conditions can cause lumps around the wrist.
Ganglion cysts are usually noticed as a bump on the hand or wrist. Most people notice they may gradually change in size, and sometimes come and go, often depending on activity level.
Wrist ganglion cyst example.
Typical symptoms of a ganglion cyst include:
- Pain and tenderness
- Difficulty with gripping activities
- Numbness and tingling
Most of the symptoms are thought to be the result of pressure from the cyst on surrounding structures including tendons and nerves.
Ganglion cysts may be tender, but most often it is the appearance of the cyst that bothers patients. The cyst should not adhere to the skin, and the skin should have a normal color. One test to diagnose a ganglion cyst is to hold a light source, such as a small flashlight, against the cyst. A normal ganglion cyst will trans-illuminate, meaning light will pass through the cyst indicating it is not a solid mass.
Special studies are typically not necessary, but some doctors will obtain an X-ray just to ensure the anatomy and structure of the hand and wrist is normal. If there is a question about if the bump is a cyst or something else, imaging tests including ultrasound or MRIs can be helpful.
Sometimes, wrist ganglion cysts go away with no treatment, or they may linger around or even grow larger. The cysts typically form a type of one-way valve such that fluid enters the cyst easily, but cannot escape. When the ganglion cyst becomes large enough, it will begin to put pressure on surrounding structures. This pressure can cause painful symptoms and is usually the reason these ganglion cysts are removed. There are several methods of treatment for a wrist ganglion cyst.
Many hand and wrist experts recommend no treatment for cysts at all. While some people don’t like the look of a ganglion cyst, and some people have discomfort, the cysts are generally not harmful, and many patients feel much better once reassured that the cyst is not going to cause any long-term problem. Particularly with volar ganglion cysts, the treatment can be problematic, and complications including infection, tendon injury, and recurrence of the cyst can all occur.
If the cyst can be tolerated, many experts advise they be left alone.
Putting a needle into the ganglion cyst and aspirating the fluid may work. However, the gelatinous fluid within the cyst does not always come through a needle very well. Furthermore, this treatment leaves the cyst lining behind, and the ganglion cyst will return about 50 percent of the time. The advantage of draining the cyst is that it is a simple procedure to perform, and the chance of a problem happening is very small. The downside is that the chance of recurrence is quite high.
The most aggressive treatment for a persistent or painful ganglion cyst is to remove it with a surgical procedure. During surgery, the wrist ganglion is completely excised, including the sac that surrounded the fluid. In addition, the connection to the joint or tendon sheath that supplied the fluid can be occluded. While this usually is effective, a small percentage of removed wrist ganglion will still return. Surgical treatment has been well described both as an open surgical procedure (through a skin incision) and as an arthroscopic procedure. Different surgeons have preferences for their favored approach.
Another alternative, that some call traditional, others call a bit barbaric, is to smash the wrist ganglion cyst with a hard object such as a book. This pops the cyst and ruptures the lining of the sac. While many people are familiar with this treatment, it is not considered acceptable as there is the potential for other damage from the trauma of the treatment.
Attempts to crush the cyst can result in injury. There are rare reports of fracture of the bones around the wrist associated with overzealous efforts to crush the cyst.
A Word From Verywell
Ganglion cysts are very common causes of bumps around the hand and wrist. A ganglion cyst is not cancer or a problem that requires urgent treatment, but sometimes it can be bothersome for people. When they do become a bother, treatment can be performed to help address the symptoms. Often doctors will try some simple treatments first, and if these are not successful a surgical procedure might be offered to remove the cyst.
Ganglion Cyst – StatPearls – NCBI Bookshelf
Continuing Education Activity
Ganglion cysts are synovial cysts that are filled with gelatinous mucoid material and commonly encountered in orthopedic clinical practice. Although the exact etiology of the development of ganglion cysts is unknown, they are believed to arise from repetitive microtrauma resulting in mucinous degeneration of connective tissue. They are the most common soft tissue mass found within the hand and wrist, but they are also commonly encountered in the knee and foot. Although the majority of ganglion cysts are asymptomatic, patients may present with pain, tenderness, weakness, and dissatisfaction with cosmetic appearance. Both non-operative and surgical treatments are available, but a high recurrence rate has historically plagued non-surgical treatment. Surgical excision can provide resolution of patients’ symptoms, but knowledge of the underlying anatomy adjacent to the cyst is crucial to avoid injuring neurovascular structures within proximity to the cyst. This activity reviews the etiology, presentation, evaluation, and management of ganglion cysts and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.
Identify the proposed etiological mechanisms for the development of ganglion cysts.
Describe the evaluation process for a ganglion cyst presentation, including possible diagnostic imaging.
Review both surgical and non-surgical treatment options for ganglion cysts.
Explain the importance of interprofessional team strategies for improving care coordination and communication to aid in the diagnosis of ganglion cysts and improving outcomes in patients diagnosed with the condition.
Access free multiple choice questions on this topic.
Ganglion cysts are synovial cysts that are filled with gelatinous mucoid material and commonly encountered in orthopedic clinical practice. Although the exact etiology of the development of ganglion cysts is unknown, they are believed to arise from repetitive microtrauma resulting in mucinous degeneration of connective tissue. They are the most common soft tissue mass found within the hand and wrist, but they are also commonly encountered in the knee and foot. Although the majority of ganglion cysts are asymptomatic, patients may present with pain, tenderness, weakness, and dissatisfaction with cosmetic appearance. Both non-operative and surgical treatments are available, but a high recurrence rate has historically plagued non-surgical treatment. Surgical excision can provide resolution of patients’ symptoms, but an understanding of the underlying anatomy adjacent to the cyst is crucial to avoid injuring neurovascular structures within proximity to the cyst.
Numerous theories have been presented in the past regarding the etiology of ganglion cysts with no present consensus. One theory introduced by Eller in 1746 is that ganglion cysts are the result of the herniation of synovial tissue from joints. Another theory postulated by Carp and Stout in 1926, which forms the basis of most modern belief, suggests that ganglion cysts result from mucinous degeneration of connective tissue secondary to chronic damage. Currently, most authors agree that ganglion cysts arise from mesenchymal cells at the synovial capsular junction as a result of the continuous micro-injury. Repetitive injury to the supporting capsular and ligamentous structures appears to stimulate fibroblasts to produce hyaluronic acid, which accumulates to produce the mucin “jelly-like” material commonly found in ganglion cysts.
Ganglion cysts account for 60% to 70% of soft-tissue masses found in the hand and wrist. Although they can form at any age, they are most commonly found in women between the ages of 20 to 50. Women are three times more likely to develop a ganglion cyst than men. These cysts are also frequently encountered amongst gymnasts, likely secondary to repetitive trauma and stress of the wrist joint.
Ganglion cysts are mucin filled synovial cysts containing paucicellular connective tissue. They may be filled with fluid from a tendon sheath or joint. Ganglion cysts are most commonly found (70%) on the dorsal aspect of the wrist arising from the scapholunate ligament or scapholunate articulation. Approximately 20% of ganglion cysts are located on the volar aspect of the wrist arising from the radiocarpal joint or scaphotrapezial joint. The remaining 10% of ganglion cysts can arise from multiple areas of the body including the volar retinaculum of the wrist, distal interphalangeal joint, ankle joint, and foot. Wrist volar retinacular cysts arise from herniated tendon sheath fluid that protrudes out. Ganglion cysts arising from the dorsal DIP joint are called mucous cysts and are associated with Herbeden’s nodules. They are commonly found in women between the ages of 40 and 70 with osteoarthritis.
Biopsies of ganglion cysts are not routinely indicated because of their inherently benign nature. Typical histopathological appearance is a mucin-filled synovial cell lined sac without a true epithelial lining. Ganglion cysts can be single or multiloculated. When examined under electron microscopy, their walls contain sheets of collagen fibers arranged in multidirectional layers with intermittent flattened cells resembling fibroblasts. The thick mucinous material present in the majority of ganglion cysts is highly viscous, which is attributed to a high concentration of hyaluronic acid and mucopolysaccharides.
History and Physical
The majority of ganglion cysts are asymptomatic, but patients may seek treatment because of their unsightly cosmetic appearance. Patients may present with pain, tenderness, or weakness that is exacerbated by wrist motion. Ganglion cysts usually present as firm, well circumscribed, freely mobile masses approximately 1 cm to 3 cm in size. They are often fixed to deep tissue and not to the overlying skin. Patients with volar wrist ganglion cysts less commonly may present with carpal tunnel syndrome or a trigger finger secondary to compression of the median nerve or intrusion on the flexor tendon sheath. Volar wrist ganglion cysts can also cause ulnar nerve neuropraxia and compression of the radial artery leading to ischemia. Ganglion cysts will usually transilluminate on the exam.
Radiographs may be ordered to rule out any related intraosseous manifestation, but will generally be unremarkable. MRI is usually not indicated for ganglion cysts unless there is a concern for a possible solid tumor. MRI will show a well-circumscribed mass with uniform fluid intensity on T2 weighted imaging. Ultrasound can be used to differentiate a cyst from a vascular malformation and to avoid accidental puncture of the radial artery during needle aspiration of a cyst.
Treatment / Management
Asymptomatic patients can be observed and reassured that ganglion cysts are benign and may spontaneously regress. Non-surgical treatment may be attempted depending on the location of the cyst. Dorsal wrist ganglion cysts can be aspirated, but there is a much higher recurrence rate than with surgical excision. Aspiration of volar wrist ganglion cysts is not generally performed due to their proximity to the radial artery. Surgery is indicated for patients with continuing symptoms who have failed conservative management. Surgical excision is usually performed as an outpatient procedure. Dorsal wrist ganglion cysts are approached through a transverse incision made directly over the cyst. Careful dissection is performed to expose the pedicle of the cyst and to avoid rupturing it, which would make excision of the capsular attachments more difficult. The pedicle and capsular attachments should be detached as close to the scapholunate ligament as possible without disrupting the integrity of the ligament. Failure to resect the pedicle of the ganglion cyst, its capsular attachments, and part of the capsule has been associated with a high rate of recurrence. Volar wrist ganglion cysts are often close to the radial artery or sometimes may surround the vessel. Blunt dissection should be used to mobilize the artery from the cyst with care taken to avoid injuring the vessel. The palmar cutaneous branch of the median nerve arises 5 cm proximal to the wrist joint and is also at risk with volar wrist ganglion cyst excision. The most common complication of surgical excision is a recurrence, and volar wrist ganglion cysts have a higher recurrence rate than dorsal wrist ganglion cysts. Ganglion cysts have a recurrence rate of approximately 15% to 20%.
Enhancing Healthcare Team Outcomes
Ganglion cysts may be encountered by a number of healthcare professionals including the nurse practitioner, primary care provider, hand surgeon, plastic surgeon and orthopedic surgeon. These harmless lesions do not always require treatment. Only symptomatic patients should undergo treatment but if not completely excised, there is a risk of recurrence. Asymptomatic patients can be followed. The prognosis for most patients is excellent.  (Level V)
Ganglion Cyst. Contributed by StatPearls
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Ganglion Cyst – The Most Common Tumor in The Hand and Wrist
A ganglion cyst is a very common bump or mass that usually appears near joints or tendons in the hand or wrist. Common locations include the dorsal (back or top side) surface of the wrist, the palm side of the wrist, the base of the palm side of the finger, and the dorsal surface of the end joint of the finger.
You can envision what a ganglion cyst looks like by picturing a balloon filled with clear jelly, attached to a hollow stalk that comes from the joint or tendon lining. Fluid travels from the joint or tendon sheath into the stalk, and fills the balloon with fluid.
Constant motion of the hand or wrist keeps fluid pumped into the cyst and it can’t get back out. Ganglion cysts can be uncomfortable if they put pressure on nerves, tendons, or skin.
The good news is that they may go up and down in size or even go away completely on their own, without any needles or surgery. They may not be painful. Ganglion cysts are not malignant (they are not made up of cancer cells) and they don’t spread to other areas, though they may get larger or more lobulated (more lumpy). Some patients tell me they need their cyst removed because “another one popped up!” – this is usually just another lump coming from the same cyst.
How do I diagnose a ganglion cyst?
Diagnosis is based on the patient’s history (how he or she noticed the bump), where the lump is and what it feels like. Sometimes patients say they remember injuring the hand or wrist several weeks before noticing the cyst, but most patients can’t remember a specific event.
Cysts are usually round and firm. You can usually feel the smooth edges of a ganglion cyst, and you can often move the cyst around under the skin with your fingers. Cysts at the base of the finger on the palm side are usually firm, pea-sized bumps that hurt when gripping narrow objects, like a steering wheel or suitcase handle.
Putting a flashlight on the skin around the mass will make it “light up” in a darkened room (transillumination), indicating that the mass has clear fluid inside.
Cysts at the end of the finger (DIP joint cysts) near the fingernail may push on the growing nail, causing a groove in the nail. Sometimes these may drain if the skin above them gets too thin.
I usually get x-rays to look at the bones and joints around the cyst. Sometimes I can see some nearby arthritis that explains the source of the cyst fluid, but in young people there is rarely an obvious source of the mass on x-rays. Rarely a cyst will be a sign of a serious ligament injury that hasn’t been diagnosed yet.
What is the best ganglion cyst treatment?
There are non-surgical treatment options for ganglion cysts; for cysts on the wrist and cysts on the finger. The first option is to do nothing – the mass may just go away on its own. If the cyst is not painful, not limiting activity, and not too big or uncomfortable, this is a good option. A brace or splint will prevent hyperextension, the position that makes the pain worse.
Puncture or aspiration is the next thing to consider. Putting a needle in the mass may decompress it and allow the fluid inside to escape under or through the skin. Depending on where the cyst is, it may be near nerves or a major artery – make sure the doctor or nurse putting a needle in your cyst knows where these structures are.
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I use the term puncture because it’s very difficult to draw out the thick clear jelly that’s often inside ganglion cysts. Usually, if the cyst is close to the skin, the jelly comes out through the hole made by the needle. The doctor may use a numbing shot first, then a larger needle to make a small hole in the wall of the cyst. I recommend a splint after this to allow the cyst wall to seal off. This is done in the office.
These days, I send patients to have these drained under ultrasound by one of our doctors who specializes in this procedure. It’s more accurate than putting a needle in blindly.
In my experience, cysts usually come back after puncture. The longer the cyst has been there, the less likely non-surgical treatment will work.
Finally, taking the cyst out in surgery is the most reliable way of getting rid of it. Ganglion cyst excision is not just a matter of opening up the skin and “lopping it off”; the joint or tendon sheath must be exposed to get out the stalk, or root of the cyst.
This can be done with a small incision over the cyst. The exact method used depends on the size and location of the mass. Recurrence rates (chances of the cyst coming back) are very low – close to 3%.
Restrictions after ganglion excision
For patients with wrist ganglion cysts, I recommend using a wrist splint after surgery for two weeks while the soreness from the surgery goes away. During that time, I advise patients to come out of the splint three times a day and do some gentle stretching exercises. Patients can type and do light activities with their hands during this time.
Activity is rarely limited after finger or tendon cyst excision. Full use is usually allowed when the skin is healed after a few days.
Watch this video for a more detailed perspective on what these wrist cysts look like:
What Dr. Henley’s Ganglion Cyst Patients Are Saying
by Harry Lynn
I was referred to Dr. Henley by my primary physician to remove a cyst on one of my fingers. From the initial visit in Bentonville to setting up the surgery at the eye clinic in Fayetteville to the follow up visit in his office, the process was simple and straightforward, and the people at each location were friendly and effective. The outpatient surgery was done at an eye surgery facility that is also used for orthopedic surgery by Dr. Henley.There the process of check in, preparation, surgery, monitoring, and check out were done very professionally by caring people who communicated well and attended to every need and answered every question we had along the way. They made sure we understood the whole process what to expect, and how we were progressing along each step of the process.
Since I was traveling soon after the surgery, we had to arrange for stitches to be removed out of state. Dr. Noel and the staff were very accommodating to help us set this up even offering to search for an appropriate place that could perform the stitch removal for us. The surgery was absolutely pain free and my only concern afterwards was how long my finger remained numb after the surgery, which Dr. Noel later explained occurs in a small percentage of patients. Dr. Noel’s friendly yet professional manner was reassuring and he answered all my questions to my satisfaction. I would definitely recommend him, the staff, and facilities used for such surgical procedures.
by Kaylie Slaughter
Dr. Henley removed a ganglion cyst from my wrist in July at North Hills Surgery Center. Dr. henley was great and explained all of my questions and concerns thoroughly. The staff at Dr. Henley’s office and North Hills Surgery Center were exceptional. The surgery was performed perfectly and my wrist is better than ever. I’m so glad I chose Dr. Henley for my surgical needs and would highly recommend him!
by Patsy Stephens
I never knew such a small thing, could cause so much pain!!! When I first noticed a little, painful knot on my right wrist, I just assumed I had bumped my wrist and the pain would eventually go away. But as time went on, the knot and the pain got bigger! I am a Real Estate Agent and it got to the point that I could not even turn a key in a lock without excruciating pain! When it became a constant pain, I knew I had to do something.
I visited Dr. Henley and he explained my treatment options. Because I really wanted to avoid surgery, we opted for a steroid shot. After a couple of weeks after the shot, my wrist was no better so I decided to have the surgery. I know to some people, a cyst on the wrist is no big deal, but surgery is surgery, no matter what! Dr. Henley and the staff at Ozark Orthopedics, as well as the Surgery Team at McDonald Eye Associates were amazing. I had the surgery to remove the cyst and my wrist was back to normal almost immediately. Thank you Dr. Henley for taking such good care of me!!
What to Do When a Ganglion Cyst Ruptures
A ganglion cyst is a soft lump connected to a joint on your body. These cysts are noncancerous, and though they can be uncomfortable, you can live with them without treatment if you choose. However, a ganglion cyst may burst, especially during intense physical activity. If a ganglion cyst suddenly ruptures, you may feel surprised, concerned and confused about what to do next.
What happens if a ganglion cyst ruptures, and how can you take care of yourself when it does? We’re here to help give you some answers. This guide will detail what ganglion cysts are, how medical professionals treat them and what to do if a ganglion cyst bursts. We’ll also answer some frequently asked questions about ganglion cysts and ruptures.
What Is a Ganglion Cyst?
A ganglion cyst is a benign sac of tissue that often develops on the hand or wrist, usually attached to a tendon or joint. Ganglion cysts are common in the soft tissue along the back of the wrist, as 60% to 70% develop along the front or back of the wrist. The cysts contain a viscous fluid that is similar to the lubricating synovial fluid that naturally cushions the joints and tendon sheaths. The cyst may feel like an inflated, slightly mobile water balloon under the surface of your skin.
Ganglion cysts are round or oval, and they vary in size. A small cyst might be no bigger than a pea, or even so tiny that you can’t feel it in your body. Larger cysts can grow to be larger than grapes — about an inch or so in diameter — and a few may even become plum-sized. On the wrist, ganglion cysts have different names depending on their locations:
- Dorsal ganglion cyst: A ganglion cyst that develops on the back of the wrist is a dorsal wrist ganglion cyst.
- Volar ganglion cyst: A ganglion cyst on the underside of the wrist is a volar wrist ganglion cyst.
Less commonly, a ganglion cyst may form on a foot or ankle or near other joints in the body.
The cysts may increase and decrease in size, becoming larger if you engage in repetitive motions with the affected joint and smaller with less joint use. A person who does a series of push-ups every day, putting repetitive strain on the wrists, may develop a ganglion cyst that grows larger as the daily repetitions continue. Unlike cancerous lumps, these cysts never spread to other areas of the body.
Ganglion cysts are not always painful, but they can be if they sit close to a nerve in the wrist or hand. A cyst located next to a nerve may cause discomfort, numbness, tingling, diminished range of motion or muscle weakness — even if it is so small it doesn’t form a visible lump. If the cyst sits close to the joint, it can also interfere with the wrist’s movement and function.
Ganglion cysts may go away on their own as your body absorbs the fluid over time. Up to 58% of cysts resolve themselves in this way. If your cyst persists, is painful or makes it hard to accomplish daily tasks or participate in hobbies you enjoy, you may decide to seek medical treatment.
Why Do Ganglion Cysts Form?
No one is certain why ganglion cysts form. We know they grow out of the linings of joints and tendons and seem to occur when the tissue around a tendon or joint erupts out of place. They often develop when some of the lubricating fluid that cushions the joints leaks out into the area of tissue just under the skin. We also know they frequently develop in joints with arthritis or as a result of repetitive stress activities.
Scientists are not sure about the exact mechanisms of cyst formation or what people could do to prevent ganglion cysts from developing. One theory is that the body responds to injury or overuse by forming the cyst as a sort of internal blister. Another is that small tears in the joint capsule or tendon membrane allow synovial fluid to seep out and form a cyst.
What Are Some Risk Factors for Developing Ganglion Cysts?
Doctors recognize a few risk factors that can mean a person has a higher likelihood of developing a ganglion cyst:
- Osteoarthritis: A person who already has osteoarthritis is at higher risk of developing ganglion cysts in the joints.
- Joint or tendon trauma: Ganglion cysts are also common in people who have experienced an injury to a tendon or joint.
- Age: Ganglion cysts are more likely to occur in people between 15 years and 40 years of age, though they occur in young children and older people as well.
- Sex: Ganglion cysts develop more commonly in women than in men.
Seeing a Doctor for a Ganglion Cyst
Should you see a doctor when you develop a ganglion cyst? It depends. Because these cysts often go away on their own, many people choose a wait-and-see approach, especially if the cyst is small and not causing discomfort. If your cyst is large or painful and interfering with your daily function, it may be a good idea to get a doctor’s opinion.
In an appointment for a ganglion cyst, the doctor may first perform a few simple tests, such as shining a light on the cyst to determine whether it is solid tissue or a liquid-filled sac. The physician may also touch the cyst gently to assess the level of discomfort it causes. After these tests, you might have an imaging test like an X-ray, an ultrasound or a magnetic resonance imaging (MRI) scan. These procedures can help rule out conditions such as arthritis and cancerous tumors.
The doctor might also use aspiration to confirm the diagnosis. Aspiration uses a syringe and needle to extract some of the fluid from the cyst. If the lump is a ganglion cyst, it will contain clear, almost transparent fluid.
Treatment for Ganglion Cysts
If you elect to have medical treatment for your ganglion cyst, your doctor will most likely recommend one of the following options:
- Immobilization: Your doctor may suggest that you immobilize the affected joint with a splint or brace. If the joint cannot move, the ganglion cyst will often shrink, releasing the pressure on your nerves and relieving the pain.
- Aspiration: Minor aspiration is useful for diagnostic purposes, and more aggressive aspiration can remove most of the fluid from the cyst. This treatment should provide near-immediate pain relief, though it is possible in some cases that the drained cyst will slowly fill back up with fluid because the structure of the cyst is still there. Aspiration merely drains out the fluid, much like letting the water out of a water balloon that you could fill again.
- Steroid injections: Steroid injections are sometimes useful in treating ganglion cysts because of their effectiveness as pain relievers. Your health care provider may give you a steroid injection to make your everyday activities less painful. Physicians also sometimes use steroid injections with aspiration, injecting the steroid into the deflated cyst to help shrink the lesion and reduce the risk of recurrence.
- Surgery: During surgery, the physician removes the cyst and stalk of tissue connecting it to the nearby joint or tendon sheath. This type of surgery is known as ganglion excision, or a ganglionectomy. The surgeon uses general anesthesia, so you’ll be unconscious and won’t feel or remember what happens, and the surgery is an outpatient procedure, so there’s no hospital stay involved. A surgical approach is often effective, and it carries less risk of cyst recurrence. Because it is the most invasive option, many doctors prefer to try more conservative treatment methods first.
Treatment is likely to depend on the kind of ganglion cyst present. With a volar cyst, physicians sometimes hesitate to perform aspiration because of the heightened risk that the needle could damage the delicate tendons and blood vessels in the inner wrist, particularly the radial artery. Though surgical treatment is possible on a volar wrist ganglion cyst, the procedure is more complicated and the site will likely take longer to heal.
Recovery From Ganglion Cyst Removal
After having a cyst removed, you can expect to experience or take part in the following for recovery:
- Splinting: After aspiration or surgery to remove a ganglion cyst, you’ll likely have a splint on your hand for a week or more. The splint will protect the excision site and prevent you from using the affected joint too much until it has healed. You’ll want to leave the splint on only as long as your doctor recommends — wearing it longer can stiffen the joint and prolong your recovery time.
- A few weeks of recovery: Depending on the cyst’s location, you may find that a full recovery takes a couple of weeks to a couple of months. Participating in your doctor’s recommended exercises and taking care not to overexert yourself can help speed the recovery.
- Physical therapy: Physical therapy will not remove an existing ganglion cyst. However, physical therapy exercises are often useful in recovery after cyst removal. These exercises can help you restore strength and a full range of motion to your wrist and hand. Strengthening your muscles can also prevent future joint injuries, thus reducing the chances of future cyst formations.
What questions should you ask your health care provider before committing to medical treatment for a ganglion cyst? Here are a few ideas to help you get started:
- How will you determine the right treatment for my ganglion cyst?
- What risks are associated with the treatment I have planned?
- How much pain will I experience, and how should I manage it?
- How long will the recovery process take?
- How should I take care of myself during recovery?
- What activities should I avoid during recovery?
- When can I resume normal activities?
- What therapy exercises or stretches do you recommend?
- What potential issues should I be alert for, and what should I do if they occur?
- What is the likelihood the cyst will recur after treatment?
What Is a Ganglion Cyst Rupture?
Sometimes, if you don’t seek medical treatment, a ganglion cyst may rupture on its own. Ruptured ganglion cysts are particularly common in children and people who are active in sports as the cyst may rupture during a hard fall on the playground or field. Many ganglion cyst ruptures occur because of hard impacts, either because the person falls or runs into something or because the person deliberately makes hard contact with the cyst in an attempt to remove it.
What happens when a ganglion cyst ruptures? Under the pressure of the impact, the cyst bursts internally and the fluid spreads out beneath the skin. Eventually, the bloodstream absorbs it. The affected area will likely be red, sore and swollen for a few days. You might also feel a sensation similar to the feeling of water running along the location where the cyst ruptures.
How Do You Treat a Ruptured Ganglion Cyst?
A ganglion cyst rupture isn’t usually hazardous to your health, but it can be painful for several days as the fluid from the cyst leaks into the surrounding muscle tissue. Treating a ganglion cyst generally involves managing your pain until the area of the rupture feels better.
What Should I Do if a Ganglion Cyst Pops?
Let’s discuss the steps of what to do when a ganglion cyst ruptures. If a ganglion cyst bursts, you should take these actions:
- Elevate the area of the rupture as much as possible.
- Apply ice to the swollen area.
- Take over-the-counter painkillers as needed and according to the manufacturer’s directions.
- Seek medical advice if the discoloration, swelling and discomfort don’t subside within several days or if they seem to be worsening.
Frequently Asked Questions About Ganglion Cysts
Below are a few frequently asked questions about ganglion cysts and ganglion cyst ruptures:
1. Can You Pop a Ganglion Cyst?
It is physically possible to pop a ganglion cyst. Some people feel tempted to hit their ganglion cysts with heavy objects to rupture them. Ganglion cysts are sometimes colloquially known as “Bible cysts” because a common treatment method in the past was to hit them with a large, heavy book like a Bible or dictionary to cause them to rupture.
For a variety of reasons, we strongly recommend avoiding this option. Smashing your ganglion cyst with an object like a heavy book can leave you vulnerable to infection if you damage the external layer of your skin. Bacteria can enter through this wound, spread via the cyst cavity to your joint and cause a joint infection that becomes incredibly difficult to treat. Hitting your cyst can also severely damage the delicate tissues and bones of your hand and wrist.
You don’t want to end up breaking your hand, misaligning your joints or giving yourself a serious infection when safer and more effective options are available. Popping a ganglion cyst yourself leaves the cyst’s walls intact, so it may fill back up with fluid and leave you with another visible cyst on your body.
2. Does a Ganglion Cyst Hurt When It Pops?
A ganglion cyst can be painful when it ruptures. Apart from potentially being located near a nerve in your body, the cyst also discharges a substantial amount of fluid that can inflame the surrounding tissues, making them sensitive and tender.
To relieve the discomfort, you can try taking over-the-counter medications like acetaminophen or ibuprofen. Be sure to follow the label instructions carefully, and consult with your health care provider before taking any of these medications over the long term.
3. Can You Massage a Ganglion Cyst Away?
Generally, massage will not remove a ganglion cyst. Massaging a ganglion cyst can have some benefits, though — it may cause some of the fluid to seep out of the sac, making the cyst grow smaller. Though massage can provide a small amount of relief, you’ll likely want to seek professional medical treatment if the cyst does not disappear on its own.
4. Why Is My Ganglion Cyst So Painful?
Ganglion cysts are painful when they sit near the nerves that carry sensory signals to your brain. The bulging cyst puts constant pressure on the nerve, so the nerve constantly sends back pain signals. If your ganglion cyst is incredibly painful, it is likely very close to one of the nerves that run through the affected location.
5. Will Ice Help a Ganglion Cyst?
Ice is unlikely to shrink a ganglion cyst, but it can provide temporary pain relief. Try applying an ice pack — or an improvised pack like a bag of frozen vegetables — to the affected area for 20 minutes or so every few hours. Be sure to wrap the ice pack in a towel or other cloth so you don’t damage your skin. You can also use a warm compress to reduce pain. The warmth may also benefit you by increasing blood flow and promoting some fluid drainage.
If your ganglion cyst has already burst, ice can also help relieve pain at the rupture site.
6. How Long Do Ganglion Cysts Last?
The amount of time ganglion cysts are present can vary widely. It’s unlikely for a ganglion cyst to disappear overnight, but some cysts appear on your body and then disappear after a few weeks or months. Some may linger for over a year before eventually disappearing. Others may show no signs of shrinking on their own, and in that case, you may wish to seek a doctor’s advice.
7. How Do I Get Rid of a Ganglion Cyst Fast?
The best way to remove a ganglion cyst without waiting for it to go away on its own is to seek professional medical treatment. Because home remedies can hurt more than they help, it is best to talk to a doctor about ways to remove the cyst. An experienced professional can give you the best advice about removing your cyst safely and effectively.
Seek Professional Treatment at OrthoBethesda
To get caring, expert help with treating a ganglion cyst before it bursts, contact OrthoBethesda. You can come to us for a range of orthopedic services, whether for hand and wrist treatments or for help with conditions of the feet and ankles, elbows, hips, knees, shoulders or spine. We have extensive experience in treating ganglion cysts using immobilization, joint soft tissue injection and aspiration, and surgical options. We can also help rehabilitate your body after surgery with physical therapy.
Our physicians are experienced in the field, and they have access to advanced medical technology for accurate diagnostics and helpful treatment. Most importantly, our physicians and therapists are professional and compassionate in their interactions. Our team strives to figure out the best way to support you as you work toward improved health and a more comfortable quality of life.
Contact us today to book an appointment or learn more about our services.
What Causes a Ganglion Cyst on Your Foot and Ankle?: Podiatry Hotline Foot & Ankle: Foot and Ankle Specialists
As you go about your life, you can develop irritating growths on your feet and ankles that cause you discomfort or pain. These growths can have different causes, but frequently they’re non-cancerous soft-tissue masses.
According to board-certified podiatrist Thomas Rambacher, DPM of Mission Viejo, California-based Podiatry Hotline Foot & Ankle, ganglion cysts are one of the most common soft tissue lumps that occur on your foot and ankles. While not usually dangerous, these cysts can cause pain and impact your daily functioning.
Understand what’s behind foot and ankle ganglion cysts, and what to do if you discover one on your foot.
What is a ganglion cyst?
Ganglion cysts are a type of fluid-filled sac you can get on your foot or ankle, as well as other joints throughout your body. They occur when your ligaments and joints secrete fluid.
You can get a ganglion cyst on the top or bottom of your foot, and the cysts can vary in size from small to large. Ganglion cysts are non-cancerous and not typically dangerous, but they can cause pain.
Causes of ganglion cysts
It’s not known exactly what causes ganglion cysts to form. However, it’s hypothesized these are some of the likely reasons you might get a ganglion cyst on your ankle or foot:
- Injury or trauma to your foot or ankle
- Repetitive stress on your foot or ankle area
- Irritation to your nearby tendons or joints
Ganglion cyst symptoms
Many of the symptoms of a ganglion cyst are similar to other soft tissue masses. If you have any of the following symptoms, make an appointment with our doctors at Podiatry Hotline Foot & Ankle to clarify which type of cyst you have.
- A noticeable lump on the top or bottom of your foot or ankle.
- A dull ache or pain near the lump, which can mean your cyst is pushing on a ligament or tendon.
- A tingling or burning sensation, which can indicate your cyst is pushing on a nerve.
- Irritation to the lump when you wear shoes.
In general, you’re more likely to have a ganglion cyst if you have some or all of these symptoms and are in your 20s to 40s. Women are also more likely to get ganglion cysts than men.
Treating your ganglion cyst
While ganglion cysts are rarely serious, you should always get any unusual lump on your foot evaluated at Podiatry Hotline Foot & Ankle. Dr. Rambacher and his team can perform an examination to find the cause and recommend the best treatment course.
If your ganglion cyst isn’t causing you pain and isn’t interfering with your quality of life, you might not need any treatment, and the cyst might go away on its own. In these cases, our team continues to monitor your ganglion cyst and can help you find footwear that doesn’t irritate your cyst.
When the ganglion cyst is painful or makes it hard to move around, our team can usually remove the cyst through a nonsurgical procedure. This involves draining the fluid from your cyst using steroid medication that helps shrink the remainder of the cyst.
If you suspect you have a ganglion cyst or another kind of soft tissue mass on your foot or ankle, make an appointment at Podiatry Hotline Foot & Ankle online or by calling 949-916-0077.
90,000 What is the difference between a hygroma and a ganglion cyst. Are they dangerous to health | Pillkin
Sometimes bumps appear on the palms of the hands, wrists, or knuckles. They are most commonly associated with physical injury, insect bites or blisters caused by repeated movements while working. They are scientifically called “hygroma”. However, these bumps can be more disturbing than they appear, often referred to as ganglion cysts.
What is a hygroma?
Hygroma (bursa), characterized by the presence of a lump that is usually found around the joints and is manifested by inflammation of the bursa (the fluid that serves as a cushion between the tendon and the bone).Hygroma usually develops in the wrists, shoulders, elbows, knees, or hip.
Causes and symptoms of hygroma
Causes may be related to insect bites, physical injury or blisters from sports or professional activities.
Symptoms are usually pain and stiffness in the infected area. However, an infection can show up and cause fever or skin lesions.
Hygroma can be cured by taking pain relievers or applying ice to reduce inflammation and is usually not serious to your health.
Ganglion cyst (ganglion cyst)
It is characterized by the appearance of a hump in the same places as in the hygroma, but can become more serious. It may be unsightly on the wrist, but unlike a hygroma, it is caused by other factors. These cysts can appear on the wrist, on the surface of the palm, or near the thumb, or on the inside of the fingers, near a phalanx or joint.
Cyst of the ganglion on the wrist (ganglion cyst) – photo source https: // yandex.ru / images /
Cyst of the ganglion on the wrist (ganglion cyst) – photo source https://yandex.ru/images/
Causes of the cyst:
Damage, rupture in the tendon membrane or improperly healed bone fracture …
· Degenerative diseases, especially in the elderly, such as osteoarthritis, which can affect the joints near the wrist and cause soft tissue inflammation.
· Often, a benign tumor that occurs in women at a young age.
· Genetic predisposition
Symptoms on the finger joint are characterized by a rounded and compact mass, rather painful both at rest and in the movement of the finger. These cysts can grow and double in size or turn red. These growing cysts can put strong pressure on the blood vessels and nerves in the body and thus desensitize the infected area.
Danger of a ganglion cyst
A ganglion cyst can have unintended consequences and develop into a chronic disease that causes many discomfort and pain, as well as limb atrophy.Early treatment is imperative to prevent infection from entering the bloodstream and cysts on other parts of the body.
Ganglion Cyst Treatment
The good news is that this cyst cannot develop into a malignant tumor. When it comes to a cyst in a finger joint, treatment consists of a surgical procedure by pumping out the contents of the cyst.
When it comes to a cyst at the level of the wrist joint, treatment consists of pumping the cyst contents and removing it surgically.Oncologists are most specialized in treating this type of symptomatology.
Alternative pain relief methods for a hygroma or ganglion cyst
At the onset of a hygroma or cyst, pain relief can be made naturally, pending consultation with your doctor. Here are some of them:
· Apply a damp gauze pad moistened with alcohol to the affected area.
· Apply honey-soaked cabbage leaves, boiled in water, to the wrist and tie the compress with a bandage.Keep the compress for two hours and repeat the operation.
In any case, please consult your doctor first .
Take care of yourself and your health!
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Wrist hygroma MRI: causes
Hygroma translated from Greek means “liquid tumor”.This jelly-like cyst forms on the back of the wrist. Due to congenital weakness of the tissues of the joint capsule, it progresses under the influence of microtraumas and intense physical exertion. Ganglionic benign formation can periodically appear, disappear, change its size.
The initially fluid-filled pathological cavity communicates with the main articular cavity. However, over time, the communicating canal is often overgrown with connective tissue and, as a result, an independent tumor forms.And although it does not pose such a danger as a subdural hygroma, which can transform into a subgaponeurotic hematoma, it nevertheless requires a medical examination.
In accordance with the modern classification, hygromas are divided into 3 main types:
- mucosal (a consequence of deforming arthrosis of the wrist joint and traumatization of the synovial membrane by osteophytes)
forming tendon sheaths).
Fluid cysts are single-chambered and multi-chambered. The latter, thanks to the channels and branches, are able to recur and grow in nearby tissues.
Symptoms and consequences
The main symptom of a hygroma, detected during a visual examination, is the appearance of a soft tumor-like neoplasm. Sometimes it is painless, but more often patients complain of pain of varying intensity arising from pressure. Local hyperthermia (increased body temperature) is also possible.Painful sensations can increase with physical exertion.
In the case of progressive growth of a fluid cyst, nerves and blood vessels are compressed and, as a result, a deterioration in sensitivity in the fingers, dorsum and palmar surface of the hand, up to a complete loss of working capacity.
90,000 What is a ganglion cyst? Symptoms and treatment
Ganglion cysts are benign growths that most commonly occur along tendons or on the joints of the wrists or hands.Ganglion cysts can also appear on the ankles and feet. Ganglion cysts are usually round or oval in shape and filled with a jelly-like fluid.
Small ganglion cysts are about the size of a pea, and large ones are about an inch (2.5 cm) in diameter. Ganglion cysts can be painful if they put pressure on a nearby nerve. Ganglion cysts, depending on their content, can sometimes obstruct joint movement.
What is a ganglion cyst? Symptoms and treatment
Cysts most often appear on the wrists, fingers or toes, and ankles.
If you are uncomfortable with a ganglion cyst, your doctor may suggest draining the cyst with a needle. It is also possible to remove the cyst by surgery. In the absence of symptoms, treatment is not required. In most cases, cysts will go away on their own.
Why do ganglion cysts occur?
The exact cause of the cysts has not been established. Probably, their appearance is associated with chronic tissue trauma.
Symptoms of ganglion cysts
In most cases, ganglion cysts do not cause any symptoms.They can appear suddenly and then disappear just as quickly. Also, cysts can shrink or grow in size. In some cases, they cause pain, numbness, or tingling.
How is a ganglion cyst diagnosed?
First of all, the doctor will perform a visual examination of the cyst, palpate it, make sure that there is or is no fluid.
Diagnostic methods may also be required to visualize the pathological formation (X-ray examination, ultrasound, MRI) to determine the exact etiology of the cyst.
The doctor may also puncture the ganglion cyst to remove fluid.
Treatment of ganglion cysts
If the ganglion cyst is small and asymptomatic, treatment may not be necessary.
If a cyst is causing discomfort, your doctor may recommend a temporary wrist splint.
Aspiration can also be performed to puncture the cyst and drain the fluid. However, after this procedure, the cyst may reoccur.
If the above methods are ineffective, surgical treatment will be required, during which the cyst will be removed.
What is ganglion? Ganglion – ganglion cyst Intraosseous ganglion
- Chondroma (enchondroma, periosteal chondroma = ecchondroma)
- Osteochondroma (exostosis)
- Chondromyxoid fibroma
- Fibrous tumor of bone (fibrous cortical defect, ossifying fibroma, fibrous dysplasia)
- Single-chamber (solitary) bone cyst
- Aneurysmal bone cyst
- Epidermal cyst
- Giant cell bone tumor
Benign tumors are most often found incidentally.For example, a neoplasm can be detected on an x-ray taken for an injury. Benign tumors are clearly delineated, do not show a tendency to rapid growth and destruction of bone and soft tissues. Clinical manifestations are poorly expressed. The pain is not typical. Benign tumors go through the following stages of development:
- Stage 1: asymptomatic. They may be patentable (do not proliferate) and no treatment is required in such cases.
- Stage 2: An active process, often requiring an operation.Relapse is possible.
- Stage 3: Aggressive process with destruction. A wide excision is required.
Usually tumor forming cartilage. Most often it appears on the hand (50% of all enchondromas are found in the bones of the hand). It is usually detected by chance after a pathological fracture. Similar tumors in large bones are unlikely; a single hand enchondroma almost never degenerates into a chondrosarcoma.
On radiographs, well-defined osteolytic changes with thinning of the cortical layer are revealed.
Therefore, treatment of asymptomatic enchondromas is not indicated. If a patient is referred for a pathological fracture, first they wait for the fracture to heal, and then curettage and bone grafting are performed.
Multiple enchondromas. Not inherited.
Multiple hemangiomas in addition to enchondroma. With multiple enchondromas, constant monitoring is necessary due to the possibility of their degeneration into chondrosarcoma.
The second most common benign bone tumor (after nonossifying fibroma). The tumor grows from the metaphyseal region towards the diaphysis (from the adjacent joint). The cartilaginous head is histologically similar to the growth zone and stops growing at the same time as the bone.
Hereditary multiple exostosis
Autosomal dominant state. It degenerates into chondrosarcoma in 1% of cases. Treatment by excision.
Found almost exclusively in the distal phalanges or skull bones.The pathogenesis is the same as in epidermoid (or dermoid) cysts found in soft tissues: a complex (crush) injury in which the epidermal cells of the nail bed enter the distal phalanx. Manifested by swelling of the fingertip. The cyst can be seen through. On radiographs, a pathological focus is clearly visible, replacing bone tissue usually on one side of the phalanx. Treatment consists in excision (curettage) of the cyst and the need for bone grafting.
Osteoid-producing neoplasm.The peak of the frequency occurs in the second decade of life. In general, the hand and wrist do not belong to a typical location, but when a tumor occurs on the hand, the proximal phalanx is most often affected. There are descriptions of cases of osteoid osteoma in the bones of the wrist. It is manifested by pain, which intensifies at night and is relieved by aspirin. Less than 10% of cases are painless. Pain characteristics may vary depending on the location. The pain is dull and difficult to localize with osteoid osteoma of the wrist bones, with a phalanx tumor, it is acute and easily localized.With periarticular localization of the tumor, reactive edema of the joint is possible, more pronounced when the finger is affected (it causes dactylitis).
- The radiographs show a characteristic osteolytic focus surrounded by reactive sclerosis. The manifestation varies depending on the severity of the two components, that is, osteolysis and reactive sclerosis.
- A three-phase bone scan with technetium 99 gives almost 100% sensitivity.
- CT – highly specific.
- MRI – allows you to differentiate between hypervascular osteoid osteoma and other hypovascular conditions.
- NSAIDs for pain relief. Remission is possible for a long period of time (2-20 years).
- Operation: curettage or resection of the affected area of the bone. The key point is the exact intraoperative localization of the tumor, since a relapse will develop after incomplete excision. To reduce the consequences of surgical treatment, the latest percutaneous techniques have been proposed, which include ablation through a drilled or trocar canal in the bone or radiofrequency ablation and laser treatment.Relapse occurs in 5-25% of cases.
Giant cell bone tumor
Locally aggressive tumor. Children commonly have aneurysmal bone cyst, chondroblastoma, osteoid osteoma, and osteoblastoma. Giant cell reparative granuloma is also similar, but spindle-shaped rather than giant cells are characteristic of it. More common in women. Metastasizes to the lungs in about 2% of cases.
Symptoms and signs
Joint effusion and pain.A pathological fracture is also possible, although the tumor does not normally break through the articular cartilage into the joint cavity.
- Radiography: lytic changes in the epimetaphysis area.
- Chest x-ray to exclude metastases.
Curettage, treatment of tumor walls with a cutter and adjuvant chemoablation (auxiliary) using phenol, hydrogen peroxide or liquid nitrogen. The cavity is then filled with bone cement.Relapse in 10-25%. Therefore, a wider excision of the tumor and surrounding soft tissues is recommended. If the distal metaepiphysis of the radius is affected, bone grafting with an allograft or reconstruction using a free peroneal graft is possible. Radiation therapy is contraindicated as it promotes tumor recurrence.
Rare tumor. It occurs mainly in men aged 20-40 years. It is manifested by mild pain and slow tumor growth.On radiographs it looks like a multi-chamber bone cyst. The histological picture can be misinterpreted as chondroblastoma or chondrosarcoma. Excision of the tumor with or without bone grafting is recommended.
Aneurysmal bone cyst
Rarely occurs on the hand, but may develop in the phalanges, metacarpals and wrist bones. X-ray reveals expansion of the bone with the formation of septa and destruction of the cortical layer, which can give the impression of a malignant tumor.Differential diagnosis includes giant cell bone tumor. Treatment should begin with a biopsy to exclude an unreasonable extended resection, since these tumors may not be operated on, and involution is possible with the formation of a layer of reactive bone along the periphery. Recovery can be accelerated with curettage and bone grafting.
It is rare and is sometimes detected by chance, like a find on radiographs. It can manifest itself as weakness and dull pain.The diagnosis is determined by conventional radiography, but CT or MRI is required to clarify the shape and size. Treatment is not necessary if symptoms are found by chance and no symptoms are present. The method of choice in the presence of complaints and clinical manifestations is curettage and bone grafting under X-ray control.
For the first time, intraosseous ganglia were discovered by J. Hicks (1956) outside the hand.
Being not true tumors, but a kind of synovial cysts, intraosseous ganglia should first of all arise in areas where there is a great tendency to ganglion formation, and, therefore, finding such lesions in the area of the wrist or ankle joints is natural.
To date, more than two dozen intraosseous ganglia have been described with involvement of the wrist joint – in the scaphoid, lunate, triangular, pisiform, uncinate bones, in the head and styloid process of the ulna, but the lunar bone lesions (sometimes bilateral) clearly predominate.
Intraosseous ganglia are thought to arise by intrusion of “ganglion-like” connective tissue into bone. The permanent subchondral location of at least one of the ganglion poles is to a certain extent confirmed
Fig.89. Intraosseous ganglion of the capitate bone in a 53-year-old patient, which appeared against the background of the pseudarthrosis of the scaphoid bone 18 years ago (radiographs).
a – subchondral oval enlightenment in the outer-proximal quadrant of the capitate bone with clear boundaries and a sclerotic rim; complicated pseudarthrosis of the scaphoid with pronounced deforming arthrosis and free position of the proximal fragment, which created an impression on the head of the capitate bone; b – one year after excohleation of the lesion in the capitate bone with filling of the defect with spongy shavings and radial-scaphoid arthrodesis.
is waiting for such an assumption. Often, slit-like defects and passages are found in the articular surfaces of the bones, through which, apparently, the synovial fluid penetrates into the bone or the synovial membrane penetrates with its proliferation. Previous injuries or diseases leading to a violation of the articular cartilage are the impetus for the formation of the intraosseous ganglion, and in a number of observations their occurrence is preceded by fractures of the ankles, scaphoid bone.
Lesions are found less frequently in women than in men.Although ganglia are found in different age groups, they are most often in middle age (from 40 to 55 years). In a third of patients, intraosseous ganglia are combined with soft tissue.
The clinical picture is rather variegated – from asymptomatic to localized aching pains at rest, aggravated by exertion and after them. Intense bursting pains are frequent.
The X-ray picture is typical. Direct radiographs reveal a large radiolucent round or oval focus (sometimes reaching 1.5-2.0 cm) with a pronounced subchondral presentation.The contours of the defect are clearly defined (smooth or slightly wavy) with a dense sclerotic wall. Such foci can also be multilocular.
During the operation, when the lesion is opened, usually from the rear, they fall into a large cavity, from which, under pressure (often), a transparent viscous yellowish liquid or even a thick jelly-like mass flows out. The walls of such defects are lined with a whitish, dense and rather thick shell (with spurs), which is easily and completely husked. After processing, the cavity of the defect is filled with cancellous shavings (Fig.89). As a rule, there are no relapses after operations.
Intraneural cyst (ganglion) is a rare non-tumor (pseudotumor) cyst caused by the accumulation of thick mucinous fluid enclosed in a dense fibrous capsule (the term “ganglion” does not mean the presence of ganglion cells in the cyst, the etymology of this word comes from the ancient – knot, swelling under the skin “, by analogy with which the name was given).
Intraneural cyst is a rare and uncommon cause of peripheral nerve damage.As a rule, large nerve trunks are affected, mainly in the lower limb, located mainly at the level of the knee and ankle joints. The most common intraneural cyst occurs in the peroneal nerve at the level of the fibular head. In the world literature, single clinical observations are described that illustrate the formation of ganglion in the radial, ulnar, sciatic, tibial and even sural nerves.
There is no consensus on the causes of intraneural cysts.The most recognized is the articular (synovial) theory, originally proposed for intraneural cysts of the peroneal nerve (which make up the vast majority of all intraneural cysts described in the literature). According to this theory, the point of entry of the interosseous contents of the cyst into the peroneal nerve is the recurrent articular branch of the nerve that goes to the tibiofibular joint and perforates its articular capsule. Along the path of least resistance, synovial fluid from the cavity of the tibiofibular joint is introduced intraneurally into this nerve and through it into the peroneal nerve.P. Patel et al. (2012) proposed the developmental stages of the intraneural ganglion from stage 0, which is the presence of a cyst within the capsule of the superior tibiofibular joint, to stage 4 with the spread of the cyst up to the division of the sciatic nerve with a possible transition to the tibial nerve.
shows the stages of development of a cyst (intraneural ganglion) according to Patel using the example of the tibial nerve (illustration from the article by P. Patel, W.G. Schucany “A rare case of intraneural ganglion cyst involving the tibial nerve”)
The clinical picture of neuropathy in the ganglion of the peroneal nerve is determined by the standard symptomatic complex of the lesion, but the peculiarity is the presence of pain syndrome, which sometimes becomes remitting in nature, which is possibly associated with pressure drops in the cyst.Considering the fact that the increase in the thickness of the intraneural cyst is limited by the epineurium, the pressure in the nerve tissue probably grows rather quickly and the disease in a short time leads to a clinical picture of neuropathy with severe motor disorders, manifested by paresis of varying severity of all long extensors of the foot and toes, short extensors of the fingers and thumb, as well as the peroneal muscles that perform the function of pronation of the foot. Characterized by sensitive disturbances in the form of hypesthesia or anesthesia along the anterolateral surface of the lower third of the leg, the back of the foot and in the toes.In most cases, a pronounced Tinel symptom is detected from the level of the projection of the intraneural ganglion.
appearance of the patient’s lower extremities (photo): lack of active extension of the left foot
Topically determining the lesion of the peroneal nerve in the area of the popliteal fossa and the head of the fibula according to the examination of the patient is usually not very difficult: if in the area of the head of the fibula it is possible to detect a pathological formation, with percussion of which Tinel’s symptom occurs, it is necessary to carry out a differential diagnosis between cystic (intraneural process) and tumor lesion with compression of the nerve (extraneural process).
When making a diagnosis, neurosurgeons and orthopedic traumatologists rely mainly on the clinical manifestations of pathology, anamnestic data and the results of examination of the patient, but this is not enough to determine the nature of the pathological process in the trunk of the peripheral nerve (intra- or extraneural), and the exact localization of the focus, which requires the use of additional survey methods.
Currently, the method of choice in the diagnosis of soft tissue masses, including the peripheral nervous system, is magnetic resonance imaging (MRI).On MRI, the intraneural cyst has a clear counter and hypointense characteristics in the T1 mode, a hyperintense signal in the T2 mode. With contrast enhancement, there is no accumulation of contrast agent by the cyst capsule. It should be remembered that various anatomical variants of the course of a nerve do not always allow obtaining its image using clear orthogonal projections in a tomographic section. For small formations, this can seriously complicate the interpretation of the results.
MRI of the proximal tibia: a – ganglion (1) located above the head of the fibula (2), originating from the common peroneal nerve (arrow), STIR-weighted images; b – ganglion of the common peroneal nerve (1), extending into the joint space of the proximal tibiofibular syndesmosis (arrow), T2-weighted images of the appearance of the patient’s lower extremities (photo): Lack of active extension of the left foot
Ultrasound is now widely used for the diagnosis of intraneural cysts.Intraneural ganglia echographically have the form of an anechoic space-occupying mass with a clear, even contour, often located eccentrically relative to the nerve, but necessarily associated with the nerve trunk.
echogram of the intraneural ganglion (1) on the pedicle (arrows) located above the neck of the fibula (2), originating from the common peroneal nerve (B-mode, longitudinal scanning)
If the mass is small, and also if it is localized at an oblique angle to the tomographic slices, then performing MRI and interpreting the results obtained can be difficult.Therefore, ultrasound can be both a screening and the main method for diagnosing an intraneural cyst (ganglion).
Radiography (of the knee joint area) in the presence of a cyst of the nerve trunk or soft tissues is not of great importance for diagnosis and can be performed only to exclude bone pathology (bone anomalies) and bone traumatic lesions (without obtaining other significant additional information). Computed tomography, as well as radiography, in this pathology also does not provide the required amount of information.
Treatment of an intraneural cyst (ganglion) surgical (!
however, it should be borne in mind that even with a complete visual removal of an intraneural cyst, its recurrence rate reaches 30%). Only if a cyst is accidentally found and there are no clinical manifestations, dynamic observation with regular ultrasound or MRI control is possible.
Intraneural ganglion (arrow) of the common peroneal nerve (photo): a – the appearance of the ganglion in the operating field, b – the stage of removal of the intraneural ganglion
Considering the risk of coagulation of the nerve’s own vessels during dissection of its membranes and the possible increase in the severity of neurological disorders due to nerve ischemia during open surgery, a number of authors suggest puncture removal of the cyst contents under ultrasound guidance.However, puncture removal is associated with a high risk of cyst recurrence, therefore, after puncture aspiration, repeated studies are necessary in dynamics to control possible recurrences, which limits the use of this method.
© Laesus De Liro
Ganglia are the most common tumor-like formations found on the hand and fingers. These “bumps” grow where there are movable cavities filled with fluid, that is, above the joints, tendon sheaths.
What is it?
This is a protrusion of the shell of the joint, a hernia, which has been detached from the maternal lane. Education is absolutely benign. Not a single case of ganglion malignancy has been described. The walls of the ganglion, after its separation, continue to produce fluid – the lubricant of the joint. Due to the lack of movement, it does not mix, thickens, turning into a jelly-like mass.
Why do ganglia arise?
The cause of the ganglia is unknown.More often occur in young women, with hypermobility in the joints. Probably as a result of thinning, weakness of the articular membrane against the background of a greater than usual difference in the pressure of intra-articular fluid in different positions of the joint.
How is the ganglion manifested?
On the back of the wrist joint, a mass develops, which is more noticeable in flexion of the joint. The skin over the ganglion always moves easily, and the ganglion is connected to the underlying joint. With a large size, the ganglion can restrict movement in the joint, squeeze adjacent tendons and nerves.In doing so, cause pain. Sometimes the ganglion disappears spontaneously.
If a synovial cyst arises from the tendon sheath, it appears as a dense “ball” at the base of the toe. The size usually does not exceed a grain of rice. With a fist grip, such a ganglion can cause inconvenience and pain.
A ganglion from the distal joint of the finger (closest to the nail) can deform the nail plate. In this zone, it almost always occurs at an older age, against the background of arthrosis in the joint.
How to treat?
If the ganglion does not cause pain or other inconvenience, then it is advisable to observe it for several months. Perhaps it will disappear on its own.
If symptoms are present, treatment may be initiated by attempting to pump out the contents of the ganglion through the puncture and apply a pressure bandage. In some cases, a small amount of a drug that inhibits the production of fluid by the walls of the ganglion is injected into the cavity. The success rate for this procedure is approximately 50%.
The most radical and effective treatment is the removal of the ganglion.With ganglia in the area of the wrist joint, it is possible to remove it through a skin incision and remove it from the inside, under the control of an arthroscope video camera inserted into the joint cavity. This method is becoming more and more popular in the world. The advantage of the endoscopic method is the minimum amount of scarring on the skin.
Is a relapse possible?
The likelihood of a ganglion recurrence in the same place after surgery is small. It is 1-2%.
Ganglion Cyst (Cyst, Ganglion; Ganglion)
What is a ganglion?
Ganglion is a cyst, in the form of a cavity filled with fluid.The ganglion is usually located in the area of tissue that surrounds the tendons or joints of the hands. Ganglia most commonly appear on the back of the wrist. But they can also appear on the underside of the wrist, fingers, or toes. The ganglia are not cancerous.
Causes of ganglion
The cause of the ganglion is unknown.
Risk factors for ganglion
Ganglia are more common in young men and women. Playing sports in which a lot of repetitive wrist movements increase the likelihood of developing ganglion.
Ganglion symptoms may include:
- Soft bump, usually on the back of the wrist;
- Pain or tenderness at the site of the swelling. Sometimes ganglia are not painful.
Diagnostics of the ganglion
The doctor will ask about your symptoms and medical history, and perform a physical examination. Most ganglion cysts are easily diagnosed based on location and appearance.
If the diagnosis is not clear, the doctor may order an X-ray of the internal structures of the problem area, or perform a biopsy to confirm the diagnosis.
Treatment of ganglion
Some ganglia disappear on their own without treatment. If the cyst is painful or unaesthetic, your doctor may prescribe treatment. However, even after treatment, the ganglion may reappear.
Note: Do not try to break the cyst with a heavy object. This is unlikely to rid you of the cyst, and is more likely to result in injury.
Treatment of ganglion includes:
Monitoring the state of the ganglion
Since many ganglion cysts disappear on their own, the doctor may not attempt to intervene while observing her condition.
A splint may be needed on the wrist. Ganglion cysts are usually small with little wrist activity, and enlarge with increasing exercise.
A needle is inserted into the cyst to drain the fluid.
A steroid drug is injected into the cyst. This is usually done after the ganglion has been drained.
Operation to remove ganglion
The cyst can be surgically removed.The operation is performed if the cyst is large and causes pain and discomfort. However, the cyst may reappear even after surgery.
Prophylaxis of ganglion cysts
INTERNATIONAL NON-PROPERTY NAME:
Betamethasone / Betamethasone
MEDICINAL FORM: suspension for injection
Description: Slightly viscous liquid containing white particles, free from foreign impurities.
1 ml of suspension contains:
Active substances: betamethasone dipropionate 6.43 mg (equivalent to 5 mg betamethasone), betamethasone sodium phosphate 2.63 mg (equivalent to 2 mg betamethasone).
ATC PREPARATION CODE: H02AB01.
Rebospan is a synthetic glucocorticosteroid (GCS) drug with high glucocorticoid and low mineralocorticoid activity.The drug has anti-inflammatory, anti-allergic and immunosuppressive effects, and also regulates carbohydrate homeostasis and water-electrolyte balance.
Betamethasone has no clinically significant mineralocorticoid effect. In addition to affecting the inflammatory and immune processes, glucocorticoids also affect the metabolism of carbohydrates, proteins and lipids. In addition, glucocorticoids act on the cardiovascular system, skeletal muscle, and the central nervous system.
Influence on inflammatory and immune processes. The anti-inflammatory, immunosuppressive and antiallergic properties of glucocorticoids are important when used in therapeutic practice. The main results of such properties are: a decrease in the number of immunoactive cells in the focus of the inflammatory process, a decrease in vasodilation, stabilization of lysosomal membranes, suppression of phagocytosis, and a decrease in the production of prostaglandins and related substances. The anti-inflammatory activity of the drug is approximately 25 times higher than that of hydrocortisone and 8-10 times higher than that of prednisolone (in weight ratio).
Influence on the metabolism of carbohydrates and proteins. Glucocorticoids stimulate protein catabolism. In the liver, through the process of gluconeogenesis, the liberated amino acids are converted into glucose and glycogen. The absorption of glucose in peripheral tissues is reduced, leading to hyperglycemia and glycosuria, especially in diabetic patients.
Influence on lipid metabolism. Glucocorticoids have a lipolytic effect. Lipolysis is most pronounced at the level of the extremities. In addition, glucocorticoids affect lipogenesis, which is most pronounced in the trunk, neck and head regions.Together, these effects lead to the redistribution of lipid deposits.
Betamethasone sodium phosphate and betamethasone dipropionate are absorbed at the injection site, providing a rapid onset of therapeutic action, as well as other local and general pharmacological effects.
Betamethasone sodium phosphate dissolves rapidly in water and is metabolized in the body to betamethasone (biologically active glucocorticoid). 2.63 mg of betamethasone sodium phosphate is equivalent to 2 mg of betamethasone.
The use of betamethasone dipropionate allows a long-term effect of the drug to be achieved. This substance is practically insoluble, being de-po, so absorption is slower and symptom relief lasts longer.
Betamethasone is metabolized in the liver. Binding occurs mainly with albumin. In patients with liver disease, the metabolism of betamethasone is longer or slower.
INDICATIONS FOR USE:
Corticosteroid therapy is an adjunct and does not replace conventional treatment.
Intramuscular administration: Rebospan is indicated for the treatment of various rheumatological, dermatological, allergic, systemic diseases of the connective tissue and other diseases in which a response to corticosteroid treatment is usually observed.
Intra-articular and periarticular administration, as well as administration directly into soft tissues: as an auxiliary short-term therapy (in acute form or exacerbation of the disease) for osteoarthritis, rheumatoid arthritis.
Intradermal administration: for dermatological diseases.
Local injection into the tissues of the foot: as an auxiliary short-term therapy (in acute form or exacerbation of an existing disease) for bursitis against the background of hard calluses, spurs, stiffness of the big toe or deformity of the big toe, with synovial cyst, Morton’s metatarsal neuralgia, ten – complete, periostitis of the cuboid bone.
Allergic conditions: bronchial asthma, status asthma, seasonal or perennial allergic rhinitis, severe allergic bronchitis, contact dermatitis, atopic dermatitis, hay fever, angioedema, serum sickness, drug hypersensitivity reactions or insect bites.
Rheumatic diseases: osteoarthritis, rheumatoid arthritis, bursitis, lumbago, sciatica, coccidinia, acute gouty arthritis, torticollis, ganglion cyst, ankylosing spondylitis, sciatica, exostosis, fasciitis.
Dermatological diseases: atopic dermatitis (coin-shaped eczema), neurodermatitis (limited neurodermatitis), contact dermatitis, severe solar dermatitis, urticaria, hypertrophic lichen planus, lipoid diabetic necrobiosis, alopecia areata, discoid lupus erythematosus, psoriasis, herpetirhoea dermatitis, cystic acne.
Systemic connective tissue diseases: with exacerbation or as a maintenance treatment for certain types of disseminated systemic lupus erythematosus, polyarteritis nodosa, systemic sclerosis and dermatomyositis.
Oncological diseases: as a palliative therapy for leukemia and lymphoma in adults, as well as acute leukemia in children.
Other conditions: adrenogenital syndrome, hemorrhagic rectocolitis, Crohn’s disease, sprue, pathological changes in the blood that require glucocorticoid therapy, nephritis, nephrotic syndrome.
In the presence of primary or secondary adrenal cortex insufficiency, treatment with the drug Rebospan can be carried out, however, if necessary, mineralocorticoids must be used simultaneously.
– hypersensitivity to drug components or to other GCS;
– systemic mycoses;
– with intra-articular administration: unstable joint, infectious arthritis;
– intramuscular administration in patients with idiopathic thrombocytopenic purpura.
From the cardiovascular system: chronic heart failure (in predisposed patients), increased blood pressure.
From the musculoskeletal system: muscle weakness, steroid myopathy, loss of muscle mass.
From the digestive system: erosive and ulcerative lesions of the gastrointestinal tract with possible subsequent perforation and bleeding, pancreatitis, flatulence, nausea, vomiting.
From the side of the central nervous system: convulsions, increased intracranial pressure with edema of the optic nerve head (more often at the end of therapy), dizziness, headache, euphoria, mood changes, depression (with severe psychotic reactions), irritability, insomnia.
From the endocrine system: menstrual irregularities, Itsenko-Cushing’s syndrome, decreased carbohydrate tolerance, steroid diabetes mellitus or latent diabetes mellitus manifestation, increased need for insulin or oral hypoglycemic drugs.
On the part of the skin: impaired wound healing, atrophy and thinning of the skin, petechiae, ecchymosis, increased sweating, dermatitis, rash, urticaria.
On the part of the immune system: corticosteroids can suppress skin tests, mask symptoms of infection and activate latent infection, as well as reduce resistance to infectious pathogens, in particular mycobacteria (in tuberculosis), Candida albicans and viruses.
Allergic reactions: anaphylactic reactions, shock, angioedema, decreased blood pressure.
DOSAGE AND METHOD OF APPLICATION:
Reospan should not be administered intravenously or subcutaneously!
Shake the ampoule before use.
THE DOSE IS SELECTED INDIVIDUALLY DEPENDING ON THE NEEDS OF THE PATIENT, THE TYPE OF THE DISEASE, ITS SEVERITY AND THE RESPONSE OF THE PATIENT’S BODY.
With systemic therapy, the initial dose of the drug in most cases is 1-2 ml.The introduction is repeated if necessary. The drug is injected deep intramuscularly into the buttock. For serious diseases, when urgent treatment is necessary, for example, with systemic lupus erythematosus or status asthmaticus, the initial dose of the drug may be 2 ml.
For various dermatological diseases, a good response is usually achieved after intramuscular administration of 1 ml of the drug Reospan; the administration of the drug can be repeated depending on the therapeutic effect.
In diseases of the respiratory system, relief of symptoms is achieved a few hours after the intramuscular injection of the drug Rebospan. In bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis, effective symptom control is achieved after administration of 1-2 ml of the drug.
In acute or chronic bursitis, effective results are achieved after one intramuscular injection of 1-2 ml of the drug Rebospan.If necessary, you can repeat the administration of the drug.
The simultaneous use of a local anesthetic drug is necessary only in isolated cases (the injection is practically painless). If the simultaneous administration of an anesthetic drug is desired, then Rebospan can be mixed (in a syringe, not in a vial) with a 1% or 2% solution of lidocaine hydrochloride, procaine hydrochloride or similar local anesthetics using paraben-free dosage forms.The use of anesthetics containing methylparaben, propylparaben, phenol and other similar substances is not permitted. First, the required dose of the drug Reospan should be drawn into a syringe from a vial; then the required amount of local anesthetic is taken into the same syringe and shaken for a short period of time.
In acute bursitis (subdeltoid, subacromial and prepatellar): injection of 1-2 ml of the drug Reospan directly into the synovial bursa can relieve pain and completely restore mobility within a few hours.
For chronic bursitis: if a good effect is obtained after an emergency treatment, the dose of the drug can be reduced.
In case of tendinitis, tendosynovitis and peritendinitis: in the acute stage of the disease, one injection of the drug may be enough to improve the patient’s condition, in the chronic one, repeated administration of the drug may be required, depending on the patient’s condition.
In rheumatoid arthritis and osteoarthritis: intra-articular administration of the drug in a dose of 0.5-2 ml, as a rule, reduces pain, soreness and stiffness of the joints within 2-4 hours after administration.The duration of the therapeutic effect of the drug varies significantly in these two diseases and can be 4 or more weeks.
Intra-articular administration of the drug Reospan is well tolerated both from the joints and periarticular tissues.
Recommended drug doses:
– When injected into large joints (eg knee, hip): 1-2 ml;
– When injected into the middle joints (eg elbow): 0.5-1 ml;
– When injected into small joints (eg joints of the hand): 0.25-0.5 ml.
In case of skin diseases: in case of dermatological diseases, the administration of the drug Rebospan directly into the lesion is effective. The beneficial effect on some lesion sites where the drug is not directly applied may be due to a slight systemic effect of the drug.
The dose is 0.2 ml / cm2. The drug is injected intradermally (not subcutaneously) using a tuberculin syringe with a needle with a diameter of 26C.The total amount of the drug injected into all affected areas should not exceed 1 ml.
For diseases of feet that are sensitive to glucocorticoid therapy: in case of bursitis against a background of calluses, the use of two consecutive injections of the drug, 0.25 ml each, can be effective. In other conditions, such as a stiff toe (Hallux Rigidus), varus deformity of the fifth toe, and acute gouty arthritis, improvement can come very quickly.Tuberculin syringe with 1,9 cm needle 25C is suitable for most injections in the foot. The recommended doses (with intervals between injections of about 1 week) are:
– against the background of hard corn 0.25-0.5 ml;
– with a spur of 0.5 ml;
– with stiffness of the big toe 0.5 ml;
– with varus deformity of the fifth toe, 0.5 ml;
With a synovial cyst 0.25-0.5 ml;
With Morton’s metatarsal neuralgia 0.25-0.5 ml;
With tenosynovitis 0.5 ml;
With periostitis of the cuboid bone 0.5 ml;
In acute gouty arthritis 0.5-1 ml.
Rebospan must not be administered intravenously or subcutaneously!
Serious neurological reactions (sometimes fatal) have been reported with injected epidural corticosteroids. The safety and efficacy of epidural corticosteroid administration has not been established, therefore such use of corticosteroids is prohibited.
The introduction of the drug should take place under aseptic conditions.
Rebospan contains two esters of betamethasone, one of which (betamethasone sodium phosphate) is rapidly absorbed at the injection site.
Dose reduction should take place under close medical supervision. In addition, sometimes it is necessary to observe the patient’s condition for a period of up to 1 year after the end of long-term treatment or after the use of high doses of the drug.
With long-term corticosteroid therapy, it is necessary to consider switching from parenteral to oral administration of the drug, weighing all the benefits and possible risks.
Corticosteroids must be injected deep intramuscularly to avoid local tissue atrophy.
The introduction of corticosteroids into soft tissues or directly into the lesion, as well as intra-articular administration, can have a general and local effect.
Rebospan contains benzyl alcohol, which can cause toxic and anaphylactoid reactions in newborns and children under 3 years of age. The drug should not be used in premature or full-term newborns.
The composition of the drug Rebospan includes methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216), which can cause allergic reactions (sometimes of a delayed type), and in exceptional cases, difficulty in breathing.
EFFECTS ON THE ABILITY TO DRIVE A VEHICLE AND WORK WITH MECHANISMS:
Special care should be taken when taking large doses of the drug, which can contribute to the development of effects from the central nervous system (euphoria, insomnia).Visual impairment is also possible with prolonged use of the drug.
APPLICATION DURING PREGNANCY AND LACTATION:
Due to the lack of studies on the safety of the use of glucocorticoids in pregnant and breastfeeding women, glucocorticosteroids should not be prescribed to women during pregnancy, lactation, as well as women of childbearing age, except when necessary and only after a careful assessment of the ratio of the expected positive effect and possible risks to the mother, fetus or child.
If corticosteroid therapy is indicated in the prenatal period, the expected clinical effect and possible side effects (in particular, growth retardation and increased risk of infection) should be compared.
In some cases, it is necessary to continue corticosteroid therapy during pregnancy or even to increase the dose (for example, in the case of corticosteroid replacement therapy).
Corticosteroids penetrate well through the placental barrier and into the mother’s milk. Since corticosteroids cross the placenta, neonates and infants born to mothers who have received corticosteroid treatment for most or any part of pregnancy should be monitored closely and examined for possible congenital cataracts, although such cases are very rare.
Since the drug Rebospan can cause side effects in breastfed babies, consideration should be given to stopping breastfeeding or the appropriateness of using the drug, depending on the importance of this therapy to the mother.
Women treated with corticosteroids during pregnancy should be monitored during and after labor and during labor to check for adrenal insufficiency due to stress during labor.
Children undergoing drug therapy (especially long-term) should be under close medical supervision for possible growth retardation and the development of secondary adrenal cortex insufficiency.
Reospan contains benzyl alcohol, which can cause toxic and anaphylactoid reactions in newborns and children under 3 years of age. The drug should not be used in premature or full-term newborns.
INTERACTION WITH OTHER MEDICINAL PRODUCTS:
Simultaneous use with phenobarbital, rifampicin, phenytoin or ephedrine can increase the metabolism of corticosteroids, and as a result, reduce the therapeutic effect.
The following treatments are contraindicated in patients on corticosteroid therapy:
• smallpox vaccination,
• other methods of immunization (especially in high doses) due to the danger of neurological complications and a weak immune response (insufficient release of antibodies).
However, in patients using corticosteroids as replacement therapy, immunization can be carried out (for example, for Addison’s disease).
The condition of patients simultaneously receiving treatment with corticosteroids and estrogens should be monitored, since the effects of corticosteroids may increase. The simultaneous use of corticosteroids and cardiac glycosides may increase the risk of arrhythmia or digitalis intoxication due to hypokalemia.
With simultaneous use with non-steroidal anti-inflammatory drugs or ethanol, an increase in the risk of developing gastrointestinal ulcers or exacerbation of an existing ulcer is possible.
In patients with diabetes mellitus, in some cases, it may be necessary to adapt the dose of oral antidiabetic drugs or insulin, taking into account the hyperglycemic effect of glucocorticosteroids.
Concomitant use of local anesthetics may rarely be necessary. If the simultaneous administration of an anesthetic is desirable, the drug Rebospan can be mixed (in a syringe, not in a vial) with 1% or 2% solutions of lidocaine or procaine hydrochloride, or other paraben-free anesthetics.The use of anesthetics containing methylparaben, propylparaben, phenol and other similar substances is not allowed.
Store in a dark place at a temperature not exceeding 25 ° C.
Keep out of the reach of children! Do not freeze.
Shake well before use.
Shelf life 3 years from the date of production. Do not use after the expiration date.
TERMS OF RELEASE FROM PHARMACIES:
Dispensed by prescription.
* For more information, see the instructions for use of the medicinal product.
90,000 💊 Operation to remove ganglion cyst, treatment and causes
What is a ganglion cyst?
A ganglion brush is a tumor or tumor (benign, not malignant), usually on the top of a joint or overlying tendon (tissue that connects muscle to bone). It looks like a bag of fluid (cyst) located just under the skin.Inside the cyst is a thick, sticky, transparent, colorless, jelly-like material. Cysts can feel hard or spongy depending on their size.
- One large cyst or many smaller ones may develop. Multiple small cysts can create more than one cyst, but they are usually connected by a common stem in deeper tissues. This type of cyst is not harmful and accounts for about half of all soft tissue tumors in the hand.
- Ganglion cysts, also known as biblical cysts, are more common (three times more common) in women than in men, and most occur in people between the ages of 20 and 40.Rarely, ganglion cysts can occur in children under 10 years of age.
- Ganglion cysts are most common on the dorsum of the hand, in the wrist joint, and can also develop on the palmar side of the wrist. When found on the back of the wrist, they become more visible when the wrist is flexed forward. Other sites, although less common, include the following:
- The base of the fingers in the palm of the hand, where they appear as small pea-sized bumps
- Tip of the finger, just below the cuticle, where they are called mucosal cysts 90 120
- Outside knee and ankle
- Top of the foot or toes
What causes a ganglion cyst?
The cause of ganglion cysts is unknown.One theory suggests that the injury causes destruction of the joint tissue, forming small cysts, which then coalesce into a larger, more obvious mass. The most likely theory is that there is a defect in the joint capsule or tendon covering (sheath) that allows the connective tissue of the joint to protrude. Chronic damage can lead to the production of mucin and fluid cells.
What are the symptoms and signs of a ganglion cyst?
- The ganglion cyst usually appears as a shock (mass) that changes in size.
- It is usually soft, anywhere from 1 to 3 cm in diameter (about 0.4-1.2 inches) and does not move.
- The edema may appear over time or appear suddenly, may decrease in size, and may even disappear, only to return at another time.
- Most ganglion cysts cause some degree of pain, usually after acute or repetitive trauma, but many are asymptomatic other than onset.
- The pain is usually non-stop, aching and aggravated by movement of the joints.
- When a cyst is associated with a tendon, you may feel weakness in the affected toe.
When should I seek medical attention for a ganglion cyst?
A histological cyst can benefit from a medical examination, whether or not there are symptoms. Your doctor can be sure you have a ganglion cyst so you don’t worry and can help you choose the best treatment plan for you.
The ganglion cyst does not need emergency treatment unless the person is seriously injured.Regular check-up with a primary doctor or a bone and joint specialist (orthopedist) can usually lead to both diagnosis and treatment of many ganglion cysts.
What exams and tests for healthcare professionals are used to diagnose ganglion cysts?
A physical examination is often required to diagnose a ganglion cyst. Most ganglion cysts transilluminate (transmit bright light).
- The physician may obtain additional confirmation by using a syringe to extract some of the fluid from the cyst (needle aspiration) or by using an ultrasound.Ultrasound is an imaging procedure that involves the use of sound waves and this can help evaluate a shock to see if it is fluid (cystic) filled or solid. An ultrasound can also detect if there is an artery or blood vessel causing the lump. The advantages of ultrasound detection include the fact that it is becoming more readily available, is fast, relatively inexpensive, and is a reliable imaging mode.
- X-rays are used very little in the diagnosis of ganglia unless a fracture or bone problem is suspected.
- A doctor may send him to a surgeon if the tubercle is hard or has a blood vessel (artery).
- Magnetic resonance imaging (MRI) is used to see the wrist and is very useful for diagnosing ganglion cysts. The disadvantage of this diagnostic method is the cost of the procedure.
treatment for ganglion cysts?
Many ganglion cysts can disappear without any treatment.
Various treatments have been proposed over the years. Some include observing the cysts without symptoms, using a needle to remove the contents of the cyst (aspiration), or surgery.
- Aspiration usually involves inserting a needle into the cyst, drawing out liquid material, and administering a steroid compound (which acts as an anti-inflammatory agent).
- Studies have shown that most people heal with a single needle aspiration.
- If you draw out the fluid three times, the chances of recovery are even higher, especially if there is a cyst on the back of the hand.
- Compared to aspiration / injection versus surgical removal, cysts generally return less frequently after surgery.
Other therapy has been attempted (eg, corticosteroids, hand squeeze, electroacupuncture), but such treatment should be discussed with a doctor before attempting as results vary.
What are the home remedies for ganglion cysts?
In the past, home care included topical plaster, heat, ice packs and various poultices. This even extended to using a heavy book to physically destroy a cyst (sometimes called “biblical therapy” or “popping a cyst”). However, these forms of treatment are no longer offered because they have not been shown to inhibit the return of ganglion cysts and may, in fact, cause further damage.
Is the operation of
effective to remove the ganglion cyst?
Ganglion cysts are the second most common selective referral to the surgeon, with the carpal tunnel being the first. Surgical removal of the cyst is necessary when the mass is painful, interferes with function (especially when the dominant hand is involved), or causes numbness or tingling in the hand or fingers. Surgery may involve simply removing the cysts through a small incision into which a camera (arthroscope) is inserted to view the area, or through a larger incision, allowing the cysts and the surrounding area to be seen directly.Arthroscopic surgery is becoming more common due to the smaller resultant scar and shorter healing time from a smaller incision.
What types of doctors treat ganglion cysts?
The types of doctors who can treat ganglion cysts vary depending on the location of the cyst and the person’s symptoms. Many people can be treated by their health care provider; others may need treatment from a podiatrist or hand surgeon.
Is follow-up necessary after treatment for ganglion cysts?
Once you have been diagnosed with a ganglion cyst and have chosen treatment, follow-up will differ depending on which one you choose.
- After a simple aspiration, your doctor may ask you to start moving the joint shortly after the procedure.
- Your joint will likely be split for 7 to 10 days after surgery. A splint is a tough sheeting that will prevent you from moving your joint. Not all doctors agree with this method (see below).
- Recent research suggests that splinting for long periods of time does not really help, and some doctors often encourage the use of a joint soon after treatment.
- Your doctor may ask you to return for an examination after surgery and decide if you need physical or occupational therapy. Follow-up treatment will be based on your personal needs.
Can ganglion cysts be prevented?
Since the cause of ganglion cysts is unknown, it is difficult to say how to prevent them. Early assessment and treatment is recommended. Since some cysts can be triggered after injury or overuse of a joint, avoiding these situations can reduce the risk of cyst formation.
What is the prognosis of a ganglion cyst?
Because it is a harmless tumor that can go away on its own or after a simple needle aspiration or minor surgery, there is a good chance of full recovery. Because ganglion cysts can return after any of these treatments, treatment alone may not be enough.
Pictures of ganglion cysts
Media file 1: Traumatic ganglion cyst. The man came to the emergency room with a painful blow after his wrist hit the car door.
Media 2: Jelly-like fluid taken from the cyst in image 1. Its presence confirms the diagnosis of ganglion cyst.
Media file 3: Ultrasound image showing ganglion cyst (area between markers) from image 1.
Media file 4: ganglion cyst that has been used in the past. This ganglion is back because this man plays cymbals in his school group.
90,000 knee joint | KinesioPro
Baker’s cyst is a fluid-filled synovial cyst that
located in the popliteal fossa.This formation is benign
cystic tumor and originate from synovial tissue. It can also occur in the area
wrists, hands and feet.
The cyst can put pressure on some anatomical structures, in most cases the popliteal vein suffers, as a result of which thrombophlebitis can develop.
Clinically relevant anatomy
Baker’s cyst is an enlarged bursa located between the medial
the head of the gastrocnemius muscle and the capsular analogue of the semimembranosus muscle – oblique
For the formation of a cyst, two conditions must be met – an anatomical connection and a chronic joint effusion. A joint effusion in the knee joint can fill the bursae of the gastrocnemius and semimembranosus muscles with synovial fluid and, if the outflow of fluid is impeded by a unidirectional mechanism, the bursae of the gastrocnemius and semimembranosus muscles enlarge, giving rise to a pseudocystic cavity, which is called Baker’s cyst.
Epidemiology / Etiology
Baker’s cyst or popliteal fossa cyst is formed if there is an initial
a problem with the knee joint, accompanied by an inflammatory reaction that
arises as a result of the formation of intra-articular bodies in the presence of osteoarthritis,
rheumatoid arthritis, rupture of the anterior cruciate ligament or meniscus, or
due to the appearance of particles as a result of knee arthroplasty, the main
way from a polyethylene liner.
- A primary cyst is
education not associated with the pathology of the knee joint.
- The secondary cyst is a distension
the synovial bag located between the tendons of the gastrocnemius and
semimembranosus muscles. The liquid enters through the channel through which the normal
the synovial bag is associated with the joint. This is the most common occurrence. 90 120 90 125
Cysts can vary in size from very
small (asymptomatic) to large, but the change in size is very
widespread.Especially in small cysts, a septum may exist,
separating the semi-membranous and gastrocnemius components. She can function
as a valve allowing fluid to enter the popliteal cyst and not leave
There are differences between the popliteal cyst in children and in adults. In children, these are cystic masses filled with gelatinous material that develop in the popliteal fossa. They are usually asymptomatic and not associated with intra-articular pathology. Spontaneous resolution often occurs, although the process can take several years.In adults, Baker’s cyst is often found in combination with other intra-articular pathologies and inflammatory conditions.
Symptoms may include:
- Uncertain pain in the area
- Edema and formation of additional
volume in the popliteal space.
- Tension in the area of edema that
may vary depending on physical activity.
- Limitations of range of motion
Most cysts are localized on the medial side of the popliteal fossa in the gastrocnemi-membranous bursa. Also, a cyst can form in the popliteal bag and then the protrusion will be in the lateral part of the popliteal space. In addition, sometimes the popliteal cyst extends upward or anteriorly.
Cysts can range in size from small to clinically asymptomatic to
not palpable, to large masses causing visible edema in
popliteal region.The size of the cyst and the intensity of the pain can lead to
limiting the range of motion. In rare cases, there will be signs and symptoms
meniscus tear, which can be checked with the McMurray test.
Popliteal cysts can exert pressure on other anatomical structures. Compression of the popliteal artery or vein can cause ischemia or thrombosis, respectively, while compression of the tibial or peroneal nerves can cause peripheral neuropathy.
See also the article: Bursitis of the crow’s feet.You can read about patellofemoral pain syndrome here.
A ruptured cyst can present with pain along the back of the lower leg or even swelling, and it can also cause itching in this area. These symptoms are more common in patients with inflammation than in patients with degenerative pathology.
Baker’s cyst can be mistaken for several other knee pathologies. The patient’s medical history, as well as clinical examination and imaging, allow the correct diagnosis of the disease.
Conditions that are accompanied by the appearance of a mass in the popliteal fossa / lower leg
Muscle strain or tear Palpable mass / tenderness, swelling / hyperemia, pain during muscle contraction and / or stretching. Contusion or hematoma of muscle Local muscle injury accompanied by bleeding or edema, painful muscle contraction / stretching. If the hematoma is old, an organized seal develops. Muscle spasm or spasm Painful palpable tightness / thickening, possible limitation of range of motion, pain on muscle strain. Fascial rupture with muscle hernia Perceptible mild mass, sharp pain in muscles with increased activity, the occurrence of local edema after physical activity. Ossifying myositis Perceptible painful hardening in the muscles, micro-tears of the muscle fibers that cause pain and swelling when the muscles contract or stretch, impaired movement due to limited muscle function. Deep vein thrombosis Constant pain, pain during passive dorsiflexion of the foot (Homan sign), local hyperemia, local tenderness on palpation of the calf and possible edema, increased body temperature. Benign tumor Local pain and tenderness, possibly a palpation sensation of softness or stiffness of the tissues, there may be a violation of movement (depending on the location). Malignant tumor Generalized malaise, possible sudden weight loss, localized pain and / or swelling of various sizes and textures. Hemangioma Present for a long time, slow changes in size over time, palpation – swelling, may be painful, may / may not restrict movement. Baker’s cyst On palpation – swelling with possible soreness in the popliteal fossa and the posterior inner part of the calf. Rupture or enlargement of Baker’s cyst (pseudothrombophlebitis) May mimic deep vein thrombosis, edema in the lower leg, sharp pain that increases with compression.
The popliteal fossa cyst can also be confused with a lipoma, which will
present less pressure resistance than a Baker cyst, or
aneurysm differentiated by ultrasound.
Differential diagnosis of seals in the gastrocnemius muscle
Possible diagnosis Supporting Evidence Denying evidence Old muscle strain or injury with scar tissue Palpation – seal No history of muscle rupture or injury, no pain while running Fascial rupture with muscle hernia Pain when walking more than 0.5 km, palpation – soreness No connection with trauma, latent onset of the disease, no pain when running or performing basic exercises Local muscle spasm Pain when walking at a distance of more than 0.5 km, tangible soreness No pain with passive stretching of the calf, no pain with resistance to muscle contraction, no limitation of mobility in the foot or knee Deep vein thrombosis Palpable tenderness, pain when sitting cross-legged, family history of increased clotting factor XII, oral contraceptive use No history of deep vein thrombosis and recent immobilization, no edema, no fever, negative Homan test, presence of pulsation at the site of injury Benign tumor Palpable induration, palpable tenderness, latent onset of disease Intermittent pain Malignant tumor Palpable induration, palpable tenderness, latent onset of disease No weight loss, no night pain or feeling unwell, intermittent pain, good general health Hemangioma Latent onset, unknown cause, hormonal changes (oral contraceptives) present for a long time, slow size change over time, palpable swelling, may be painful, not always accompanied by restriction of movement
Accurate differentiation of patient symptoms can be achieved with
If the popliteal cyst is infected, it often results in
painful lump behind the knee. In such cases, it can be difficult to place
diagnosis, and an infected cyst can be mistaken for a neoplasm. Cyst may
rupture (open up), which will lead to severe pain in the calf, decrease
movement in the ankle and will cause symptoms similar to thrombosis
deep veins (seen on ultrasound or venogram).
You may be interested in the article: Prepatellar bursitis: causes, symptoms, treatment.
It is important to diagnose a ruptured Baker cyst as early as possible to
determine the best treatment and avoid complications such as pinch syndrome,
and differentiate it from the following states:
- popliteal aneurysm;
- inflammatory arthritis;
- Calf muscle stretch;
- soft tissue tumor or rupture
Note that swelling along the anterior surface of the proximal tibia in a patient with a prior history of ipsilateral total knee arthroplasty may be due to Baker’s cyst.
Examination of knee joints with suspected popliteal cysts may
include standard radiographs, arthrography, ultrasound and MRI. In the early stages of diagnosis
simple x-rays may be helpful to identify others
conditions associated with popliteal cysts, such as osteoarthritis,
inflammatory arthritis and joint bodies (arthremphitis). In addition, free articular
bodies may be visible in Baker’s cyst on plain radiographs.
Read about pain in the anterior part of the knee joint here.
Initially, direct arthrography was used to detect popliteal cysts.
Direct arthrography included intra-articular gas or iodinated
contrast medium with subsequent mobilization of the joint to enhance contrast in
cyst. Then, point radiographs were used to determine the presence of contrast in the cysts.
or fluoroscopy. Disadvantages of this method include the use of
ionizing radiation and the use of invasive methods to administer
The advantages of ultrasound examination are its low cost,
non-invasive use and no radiation.The main disadvantage
is that it depends on the user (the training of the researcher).
Ultrasound is capable of detecting Baker cysts in almost 100% of cases, but does not allow
differentiate them from other pathological conditions such as meniscus cysts
or myxoid tumors; it also does not detect other pathologies of the knee
joint, which are often associated with these cysts.
Magnetic resonance imaging remains the gold standard for diagnosing Baker’s cysts and differentiating them from other conditions.It allows the assessment of soft tissue abnormalities and has the additional advantage of being accurate in diagnosing concomitant joint disorders, which makes it possible to assess the entire spectrum of related disorders.
Read also about the infringement of the fatty body of the patella.
Conditions such as meniscus cysts are easier to distinguish from Baker cysts using MRI than with ultrasound. Yes, MRI is considered the gold standard, but it is also an expensive method, so ultrasound should be considered a screening method if accurate assessment of intra-articular structures is not necessary.
Baker’s cyst on axial MRI with a communicating channel between the semimembranosus muscle and the medial head of the gastrocnemius muscle
Baker’s cyst on MRI, sagittal image
Targets are used to define and assess expected
the results of the therapy / procedure, which must be compared with the results,
found on the patient.
- Western Ontario and McCaster Universities Pain Subscale (WOMAC): A multidimensional instrument that measures 17 functional activities, 5 pain-related activities, and assesses joint stiffness.It measures pain and dysfunction.
- Visual Analogue Scale (VAS): Measures pain from 0 to 10 points (no pain to severe pain). It is easy for the patient to determine what level of pain they have.
- Rauschning and Lindgren classification: used to assess outcome and therapeutic efficacy (0 to 3).
- Newcastle-Ottawa Scale: A simple scale for assessing the quality of non-randomized controlled trials.
Evaluation is rather clinical observation and exclusion of others
possible states.In case of infection or severe conditions, it may be
X-ray examination is useful.
Patients with a Baker cyst usually have symptoms of a meniscus or cartilaginous
pathologies that can be detected using the McMurray test. Symptoms associated
with a popliteal cyst, rare. If these symptoms are present, then they may be
associated with an increase in the size of the cyst. The most common symptoms
are edema and pain in the popliteal fossa. Patients can also
complain of pain that occurs when the knee is fully extended.During the examination
knee flexion testing may be helpful.
We wrote about dislocation of the patella here.
In patients with large cysts, knee flexion may be impaired because the cysts mechanically block this movement. Examination often reveals pathology of the knee joint meniscus or cartilage. A palpable cyst is often hard when the knee is fully extended and soft when the knee is flexed. This phenomenon is known as the “Foucher sign” and is associated with compression of the cyst.When the knee is extended, the gastrocnemius and semi-membranous muscles come closer, and the articular capsule presses the cyst against the deep fascia. Understanding Foucher’s mechanism is helpful in distinguishing Baker cysts from lesions such as popliteal artery aneurysms, adventitial cysts, sarcomas, for which palpation is not dependent on knee position, therefore it is considered a specific Baker cyst test.
Sometimes, no treatment or simple supportive measures lead to
spontaneous resolution or reduction of symptoms.If this is not
occurs, it may be worth using invasive and surgical instruments.
Asymptomatic condition often improves and over time cyst
Baker disappears by itself. If the cyst is symptomatic, rest can moderate
pain. You can also take non-steroidal drugs to reduce pain.
anti-inflammatory drugs (NSAIDs) and ice.
If pain persists, steroid administration with
anesthetic solution, which may relieve pain but not prevent recurrence
cysts.This is only a temporary solution. In the presence of a popliteal cyst
inflammatory origin, this is enough to treat the main
diseases. When the underlying condition is not treated, Baker’s cyst can
recur. Arthroscopic examination and treatment of all pathological
conditions should be carried out before considering dissection of the popliteal cyst.
A cyst may be surgically removed if it becomes very large or causes symptoms such as discomfort, stiffness, or painful swelling.There are three surgical approaches to treat cysts: the standard posterior approach, the posteromedial approach, and the medial intra-articular approach. The first two methods are cyst removal methods. The latter method involves creating a hole in the cyst, which is later closed.
Using ice for 15 minutes every 4-7 hours will reduce inflammation.
Treatment is based on the principles of R.I.C.E (rest, ice, compression and lifting), for
followed by some muscle training exercises.
Rehabilitation program can improve knee control with
using a series of therapeutic exercises. This will increase the mobility of the joint as well
will increase flexibility. A physical therapist can design a program to improve
mobility and hamstring stretching, which can also include exercises for
strengthening the quadriceps. This will lead to pain relief in about 6-8 weeks.
There is an experiment comparing ultrasound-guided corticosteroid injections with horizontal therapy (instrumental physiotherapy).60 people were divided into three groups, injections only (group A), horizontal therapy only (group B) and (group C), in which patients received both injections and horizontal therapy. The horizontal therapy was performed using a special commercial device, and the researchers followed the manufacturer’s instructions.
- Uncertain pain in the area