| What is it? |
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In the hand, a ganglion is a particular type of lump which shows up next
to a joint or a tendon. Inside, it is like a balloon filled with a thick
liquid. It may be soft or hard, may or may not be painful, and may get
bigger or smaller on its own. It may also be referred to as a mucous cyst,
a mucinous cyst or a synovial cyst.
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| What caused it? |
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Normally, joints and tendons are lubricated by a special liquid which is
sealed in a small compartment. Sometimes, because of arthritis, an injury,
or just for no good reason, a leak occurs from the compartment. Now, the
liquid is thick, like honey, and if the hole is small, it can be like having
a pinhole in a tube of toothpaste - when you squeeze the tube, even though
the hole is small and the toothpaste is thick, it will leak out - and once
it is out, there is no way it can go back in on its own. It works almost
like a one way valve, and fills up a little balloon next to the area of
the leak. When we use our hands for normal activities, our joints squeeze
and create a tremendous pressure in the lubricating compartment - this
can pump up a balloon leak with so much pressure that it feels as hard
as a bone.
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The lubricating liquid has special proteins dissolved in it which make
it thick and also make it hard for the body to absorb it when it has leaked
out. The body tries to absorb the liquid, but may only be able to draw
out the water, making it even more thick. Usually, by the time the lump
is big enough to see, the liquid has gotten to be as thick as jelly.
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Common sites for ganglions are:
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The wrist - on the back ("dorsal wrist ganglion"), on the front ("volar
wrist ganglion"), or sometimes on the thumb side. These come from one of
the wrist joints, sometimes aggravated by a wrist sprain.
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The palm at the base of the finger ("flexor tendon sheath cyst"). These
come from the tube which holds the finger tendons in place, and are often
due to tendon irritation - tendinitis.
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The back of the end joint of the finger ("mucous cyst"), next to the base
of the fingernail. These can cause a groove in the fingernail, or rarely
can become infected and lead to a joint infection. These are usually due
to some arthritis or bone spurs in the joint.
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| What can you do to help? |
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Wait and watch.
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"Over the counter" non-steroidal anti inflammatory medication (NSAID),
such as aspirin, ibuprofen, naprosyn, or ketoprofen. Check with your pharmacist
regarding possible side effects and drug interactions.
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Some people, following non-medical advice, will smash the lump with a heavy
book, and rupture the cyst. Sometimes this works, but I don't recommend
it. The lump can come back even if it has been successfully treated this
way. The urban legend regarding this traditionally involves using a Bible
as the book, leading ganglions to be called "Giddeon's disease" in some
circles.
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Some people attempt to drain the cyst by sticking it with a needle - particularly
when the cyst is on the end joint of the finger. Don't try this at home!
It can lead to a serious infection in the joint.
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| What can a therapist do to help? |
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Provide a variety of hand splints to support the area.
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| What can a doctor do to help? |
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Confirm that this actually is the problem.
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Prescribe a custom prescription splint.
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Drain the cyst with a needle and possibly inject the area with cortisone.
This works much better for cysts coming from the tendon than those coming
from joints.
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Perform surgery to remove the cyst and clean out the area where the cyst
comes from.
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| How successful is treatment? |
It depends on several things.
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Tendon sheath cysts are more likely to be cured with a cortisone shot than
cysts coming from joints.
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Cysts coming from joints are less likely to come back after surgery if
the joint itself is "cleaned out", but cleaning the joint out increases
the chance that the joint will be somewhat stiff after surgery. For
example, cysts on the back of the wrist come back about one out of three
times give the joint is not cleaned out, but only about one out of twenty
times if the joint is cleaned out.
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Cysts on the front of the wrist (volar wrist ganglions) are more likely
to come back after surgery than cysts on the back of the wrist (dorsal
wrist ganglions).
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| What happens if you have no treatment? |
This depends on what kinds of problems you're having, but it is a good
idea to have your cyst checked out by a doctor and possibly have x-rays
to make sure that you are not ignoring a potential health problem.
For example,
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Painful cysts may be painful because of underlying problems other than
a simple cyst. Although uncommon, pain associated with a ganglion
may be due to underlying arthritis, bone tumor, ligament injury or fracture.
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Cysts can extend into the underlying bones and cause other types of problems.
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Cysts on the back of the end joint of the finger (mucus cysts) may gradually
thin and weaken the overlying skin, allowing liquid to drain out but also
allowing bacteria to enter the joint, sometimes causing a serious infection.
Once these types of issues have been evaluated by a physician, the choice
is yours. Most ganglions do not pose a serious health risk, and can
be simply left alone. Many ganglions go away on their own. Between one-third
and two-thirds of wrist ganglions eventually go alway with no treatment. |
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