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Diseases and Conditions
Ganglion cysts
From MayoClinic.com
Special to CNN.com

Introduction

Ganglion cysts are noncancerous fluid-filled lumps (cysts) that most commonly develop along the tendons or joints of your wrists or hands. They may also appear in your feet.

Ganglion cysts may develop suddenly or progress gradually. They occur when the lubricating fluid in your joints or around the nearby tendons accumulates, giving rise to a cyst. The exact cause of this process is unknown.

In most cases, ganglion cysts cause no pain and require no treatment. In many cases, ganglion cysts go away on their own. When treatment of ganglion cysts is necessary due to pain or interference with joint movement or for cosmetic concerns, it usually consists of removing the fluid from the ganglion cyst (aspiration) or surgery to remove the cyst.

Signs and symptoms

In most cases, ganglion cysts appear as raised lumps near your wrist or finger joints. They are generally round, firm and smooth. Though they are fixed in one place, they may "give" a little when you push against them.

On average, ganglion cysts are about 3 centimeters in diameter. They may change somewhat in size depending on your activity level, becoming larger when you use the affected joint and growing smaller when you're at rest.

Most ganglion cysts are painless. In some cases, however, the cysts may put pressure on the nerves near the joint, which can cause pain, weakness or numbness in your hand.

Occasionally, the telltale lump that indicates a ganglion cyst isn't visible. Often the only indication of these smaller, "hidden" ganglion cysts (occult ganglions) is pain.

Ganglion cysts may be present for years, or they may resolve on their own.

Causes

The cause of ganglion cysts isn't known.

It appears that a ganglion cyst occurs when the tissue that surrounds a joint (joint capsule) or the tissue that covers a tendon (tendon sheath) bulges out of place and fills with lubricating fluid (synovial fluid) normally found in joints or around tendons.

Risk factors

Ganglion cysts are more common in women than they are in men.

The following factors also may put you at a greater risk of forming ganglion cysts:

  • Regular, repetitive movement that stresses your wrist or hand.
  • Having osteoarthritis, the wear-and-tear type of arthritis. Osteoarthritis can increase fluid within the joints, which can then leak into the tendon sheath and accumulate in an existing cyst.
  • Injury to the joints or tendons of your hands or feet.

When to seek medical advice

If you experience any of the signs and symptoms of a ganglion cyst, including a noticeable lump or pain in your wrist, hand or foot, see your doctor. He or she can make a diagnosis and determine whether you need treatment.

Screening and diagnosis

When a ganglion cyst is suspected, your doctor will first perform a physical exam. He or she may apply pressure to the cyst to test for tenderness or discomfort.

Your doctor may also recommend an X-ray of the affected area to rule out other conditions, such as arthritis or a tumor.

A ganglion cyst diagnosis may also be confirmed by aspiration, a process in which your doctor uses a needle to draw out (aspirate) the fluid in the cyst. Fluid from a ganglion cyst will be thick, sticky, and clear or translucent.

Your doctor may also recommend ultrasound or magnetic resonance imaging (MRI) in order to gain information on the cyst's size, shape and depth.

Magnetic resonance imaging or ultrasound may also be used if your doctor suspects a ganglion cyst due to pain or tenderness, but the telltale swelling isn't visible in a physical exam. In this case, an MRI or ultrasound can help locate and diagnose the "hidden" ganglion cyst (occult ganglion).

Treatment

Ganglion cysts are often harmless and painless, requiring no treatment. In fact, in many cases, doctors recommend a wait-and-watch approach before exploring treatment options.

However, if the ganglion cyst is causing pain or it's interfering with joint movement, your doctor may recommend one of several treatment options.

Immobilization
Because activity can cause the ganglion cyst to increase in size, your doctor may recommend wearing a wrist brace or splint to immobilize the area. This helps your hand and wrist to rest, which may help the cyst decrease in size. As the cyst decreases in size, it may release the pressure on your nerves, relieving pain.

Aspiration
In aspiration, your doctor drains the fluid from the cyst.

To do so, your doctor applies a local anesthetic to the area above the cyst. Then, he or she punctures the cyst with a needle and removes the fluid from the base of the cyst with a syringe. This can be done right in your doctor's office.

Ganglion cysts may return after aspiration. In fact, the recurrence rate may be as high as 80 percent. If the cyst recurs, aspiration can be repeated. Having multiple aspirations may eventually result in no recurrence of the cyst.

Your doctor may recommend a steroid injection into the empty cyst after aspiration. Combined with aspiration, steroid injections may reduce the recurrence rate of the cyst. However, the ganglion cyst may still recur and your doctor may recommend surgery to remove the cyst.

Surgery
If you have significant pain or difficulty with joint movement, your doctor may recommend surgery to remove (excise) the ganglion cyst.

In most cases, doctors perform the surgery on an outpatient basis, which means you'll go home the same day as the operation.

Before the procedure begins, you'll undergo either local or general anesthesia. The surgeon will then make an incision in your skin at the location of the ganglion cyst. The size of the incision depends on the size of the cyst. The surgeon will remove the cyst, then suture and bandage the affected area.

After surgery, you'll be asked to keep the area elevated for up to 48 hours to help reduce swelling. You may experience discomfort, swelling and tenderness for two to six weeks. Your doctor may recommend analgesics, such as acetaminophen (Tylenol, others), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Naprosyn, others), for pain relief.

At home, you'll need to change your bandages (dressing) as directed, and apply a topical antibiotic ointment with each change. As the incision heals, it's important to watch for signs of infection, including redness, swelling or discharge.

In the weeks after surgery, your doctor may recommend physical therapy to rehabilitate your hand, wrist or foot.

Even with surgery, there's no guarantee that a ganglion cyst won't recur. In fact, according to one study, recurrence may be as high as 20 percent in the wrist and 40 percent in the foot and ankle even after surgical excision.

As with all surgeries, risks are associated with surgical excision. Though rare, injury to nerves, blood vessels or tendons may occur. These could result in weakness, numbness or restricted motion.

July 06, 2006

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