Treatment of Ganglion Cysts

A ganglion cyst is a sometimes painful lump that develops on the top or underside of the wrist or at the base of a finger. The problem is evaluated and treated by hand specialists in the Department of Orthopedic Surgery.

A ganglion grows out of a joint like a balloon on a stalk. Inside the balloon is thick, slippery fluid similar to that found in joints. The lump often gets bigger with constant, strenuous use of the hand and shrinks at rest. Sometimes the cyst disappears on its own.

Even when small, a ganglion cyst can be quite painful if it presses on nerves. Even if it does not hurt, a large one may be cosmetically unappealing. An X-ray is usually taken to rule out arthritis or a bone tumor. Sometimes an MRI or ultrasound scan is done to find a small ganglion hidden under the skin.

If the cyst is not painful, treatment may consist of nothing more than waiting and watching. A brace or splint may be recommended to immobilize the wrist and reduce swelling. If the cyst is large or painful, fluid may be drained from it with a fine needle after first numbing the skin. However, the cyst and stalk are still there and can refill with fluid.

Surgery may be recommended if the other treatments fail. Surgery is done as an outpatient procedure. During surgery, the cyst, along with a small amount of surrounding tissue, is removed. There may be tenderness, discomfort and swelling at the site following surgery, but normal activities can usually be resumed in two to six weeks. Surgery offers the best chance of removing the ganglion, but the cyst may return.

Joints are lubricated. The lubricant is a very slippery and thick (like syrup) fluid. If the joint capsule (the flexible but tough casing of the joint, like cheeks to the mouth) - if that capsule has a tiny hole in it, the fluid being thick isn't too likely to pour out into the tissues outside the joint. But, under vigorous activity and thus high hydraulic pressure, some will be forced out. The body will recognize the leak and wall it off. But if the wall isn't strong enough, it will inflate like a balloon. That balloon does not have the pressure to drive the thick fluid back into the joint - except very slowly. Sometimes, especially in certain locations where tendons press a certain way, the opening behaves like a one way valve.

These balloons can feel very firm, even hard. Typically they are rubbery. They are called ganglions (just to confuse everybody as the name really makes no sense at all). The most common ones are on the back (hairy side) of the wrists. Baker's Cysts are just ganglions found on the backs of knees. They are occasionally seen at the ankles and even in the fingers.

A simple diagnosis and treatment is to simply hold the joint still. A cast will cure most ganglia by stopping the hydraulics that inflate them. As they shrink, the math of fluid pressure in containers kicks in. The smaller the diameter, the less the wall pressure (has to do with surface area vs. cubic volume ratios). Most ganglia, given the on again-off again activities of kids, will just up and go away during a lull. The more active kids may not get that relief. When casts are used, about four weeks are needed - maybe more. Sometimes you can cut the down time by draining the cyst. But it is hard to totally dry it out with a needle so some immobility helps assure it stays away. Smashing the wrist ganglia with bibles harkens back to the days when the bibles were NOT ILLUSTRATED and were soft covered and light. A current bible can do real damage !

The set up for ganglia is common in young children. Older folks may get them as a result of making too much joint fluid (torn cartilage, or rheumatism). A Baker's cyst bursting can drop a large amount of fluid that must be removed. The chemistry used to remove that fluid inflames and may be misinterpreted as phlebitis. This is rare in kids, though common in adults