Ganglion cyst (sac of fluid) is a mass or swelling that often develops around the wrist or back of the hand. These cysts are non-cancerous, not harmful and will not spread. The cysts may feel soft, spongy or firm. It contains clear, jellylike, colourless fluid.
Symptoms
- Lump near the wrist joint – smooth, firm or round
- Variable in size – may get bigger, smaller or even go away
- May limit motion in adjacent joint
- Usually painless, unless nerves are involved which cause pain, weakness and numbness
Risk Factors
Women are more likely to be affected than men.
Some factors may put you at increase risk of developing ganglion cyst:
- Repetitive injury to the joints or tendons of your hands.
- Osteoarthritis can increase fluid in the joints, follow by leakage thru the tendon sheath into a cyst.
- Participating in sports, example: gymnastics.
Investigations
Your doctor may perform the following tests:
- Physical examination: Pressure may be applied to identify any discomfort or pain.
- Penlight: Light will pass through the cyst (trans-illumination), this can assist in diagnosis.
- X-rays: May be taken to rule out other conditions such as arthritis or tumour.
- Other Imaging: Ultrasound and MRI – to find a ganglion that is not visible and assess the cyst’s shape, size and depth.
- Aspiration: Your doctor uses a needle and syringe to draw fluid from the cyst. Fluid usually appears clear, translucent and thick.
Complications
Many people do not encounter any difficulties in mild ganglion cyst. As the cyst progresses, it might cause pain, reduced mobility of the wrist and interference with activities such as holding a mug and writing. Sometimes, large cysts, even if they are not painful, are unattractive.
Treatment
Treatment can be non-surgical or surgical.
Initial treatment is usually non-surgical. Your doctor may recommend a ‘watch and wait’ approach, as the cysts frequently disappear spontaneously.
If the cyst becomes painful or limits daily activities, your doctor may recommend one of several treatment options.
- Immobilisation: Activity can increase the size of the cyst. Applying a wrist brace or splint may immobilise the area and shrink the cyst. This may also relieve pain by releasing pressure on the compressed nerve.
- Aspiration: In aspiration, the area around the cyst is numbed with local anaesthetic. Your doctor then punctures the cyst and removes the fluid using a syringe. He or she may recommend steroid injection into the cyst after aspiration. 60% of ganglion cysts may recur and aspiration can be repeated.
- Surgery: It involves removing the cyst and along with portion of the tendon sheath and joint capsule. A local or regional anaesthetic is used to numb the area and then the surgeon makes an incision in the skin overlying the cyst to remove it. He or she will then stitch and bandage the area. Surgical treatment is generally successful although cysts may recur.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Do not over-work with your hands while not obtaining enough rest.
Avoid doing activities that seem to aggravate the pain.
An old solution of ‘smashing’ the cyst with a heavy object isn’t a good way to reduce the size of the cyst. This can be painful and damage surrounding tissues in your hand or foot. Also, ‘puncturing’ your own cyst with a sharp object isn’t a great idea as this is ineffective and can lead to infection.
F.A.Q. | Frequently Asked Questions
What is the prognosis?
Unfortunately, some ganglion cysts recur even after surgery.
What happens after surgery?
There may be some discomfort, tenderness and swelling after surgery. Keep the affected area elevated for up to 48 hours to reduce swelling. In the mean time, your doctor may recommend pain killers to relieve pain. Occasionally, your doctor may recommend temporarily wearing a splint or brace to help reduce post-operative pain. Change your dressing as directed and seek medical attention if signs of infection develop, such as redness, discharge and swelling. Normal activities may be resumed two to six weeks after surgery.
Rehabilitation
Physical therapy is usually not needed after cyst removal. But if you are experiencing joint stiffness, therapy may help you regain strength and restore movements.