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Other Names Synovial Cyst, Wrist Cyst, Bible Cyst, Cyst - Ganglion What is a Ganglion Cyst? A cyst is a fluid-filled sac. Ganglion cysts are more commonly known as wrist cysts or Bible cysts. They appear as bumps or a mass seen under the skin, usually near the wrist. They may also occur at the shoulder, elbow, knee, ankle and foot. Causes, Incidence and Risk Factors Ganglion cysts are non-cancerous masses, although they may grow in size progressively. These cysts are usually attached to underlying tendon sheaths but in certain cases may have no obvious connections to structures within a joint. The exact cause is unknown but occupations involving excessive strain on a particular joint are prime candidates. Sometimes when there is a tear in a ligament, the ligament sheath (the ligaments protective covering) becomes inflamed and as a result collects fluid. This collection of fluid manifests itself externally as a ganglion cyst. These cysts occur most commonly in the age group of 20-50 years and women are more commonly affected than men. Signs and Symptoms The first thing you may notice is a slight bump over the skin surface. The size of the bump increases over a period of time. It is usually seen on the back of the wrist, the palm of the hand or at the base of the fingers. Ganglia are often painless but pain may be felt while performing certain routine motions like gripping something, steering or holding a briefcase. Symptoms experienced include: - Swelling that increases and decreases in size. The size-change is rapid, occurring over a couple of days.
- Firm or semi-solid mass that may move when touched
- Pain during use
- Slight limitation of movement.
Screening and Diagnosis The doctor usually asks about how the swelling developed to rule out the possibility of the mass being cancerous. The more rapid the evolution and change in size of the swelling, the less are the chances of it being cancerous. The skin over the swelling is tested for its normal mobility. Any fixation, puckering or color change may indicate a more serious condition. Additionally, the transillumination test is used to rule out the possibility of cancer. The transillumination test is performed by dimming the room lights and placing a flashlight or pen light on the skin surface over the affected area. Because ganglion cysts are fluid filled, they are typically transilluminant (light up), while tumor masses are not. The doctor also looks and feels for any pulsating quality, in order to rule out the possibility of the presence of an underlying blood vessel, which may get damaged while treating the cyst. Finally an X-ray or an ultrasound examination is conducted to confirm the nature of the swelling. Treatment The most primitive way of treating a ganglion cyst is to slam a book on it with force. This breaks up the cyst and the fluid within it is absorbed, but the complications that follow are worse than the disease itself! Ganglion cysts are harmless. Once it is known that there is no cancerous potential there are two ways of doing away with it. A sure and simple way of treating a ganglion cyst is to remove the fluid by aspirating it, but usually the doctor will ask you to wait to see if the cyst will absorbed over time. If the cyst persists, then the fluid within it can be drained or aspirated. This can be performed under local anesthesia, using a sterile needle and syringe. If the cyst is deep-rooted or if it rests on an important nerve or blood vessel, a minor surgery may be required. The cyst is removed without damaging the important structures nearby. Recovery Ganglion cysts are easily diagnosed and treated with few or no complications. However, ruling out the possibility of the swelling being cancerous is of prime importance in the management of ganglion cysts. Complications: - Recurrence - 5%
- Cosmetic discomfort
- Mechanical discomfort
- Injury to nerve or blood vessel on aspiration or surgery
References - Turek's Orthopedics, Principles and Application, 5th edition. Stuart L Weinstein and Joseph A Buckwalter, Pages 433-435
- Adams, JC, & Hamblen, DL. (1990). Outline of Orthopaedics
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