Ganglion Cyst

Ganglion Cyst Cystic Hygroma

A Ganglion Cyst or cystic hygroma is a small fluid-filled sac that forms on a joint or tendon (a structure that connects muscle to bone). Depending on its size, cysts can feel firm or soft. Ganglion cysts are commonly found around the wrist and are usually benign (non-cancerous) masses. They can also occur in other joints. Typically have a round or oval shape. They may be painful and cause restricted movement in the affected joint. The fluid inside the sac is viscous, sticky, transparent, and gel-like. Ganglion cyst fluid resembles synovial fluid, but with minor biochemical and density distinctions.

Ganglion Cyst Symptoms

Cysts most commonly develop along the wrists or tendons and joints of the hand. They are also frequently found in the ankles and feet. Cysts are typically round or oval and usually under 2.5 cm in size. Some cysts may be very small and not easily felt. However, repetitive wrist movements can cause the cyst to grow. Ganglion cysts are often painless, but they can occasionally cause discomfort. Even when small in size, they can exert pressure on nerves, leading to pain, numbness, tingling, or muscle weakness.

Causes of Ganglion Cysts

The exact cause of ganglion cysts is not fully understood. The main theory is the leakage of synovial fluid and herniation of the joint capsule.

Who is at Risk

Ganglion cysts are most commonly seen between the ages of 20 and 40. They are more prevalent in women compared to men. Although rare, they can also occur in children. They are more commonly seen in individuals with rheumatic diseases due to degeneration (osteoarthritis) in the small joints of the hand. Additionally, individuals with a history of joint or tendon injuries have a higher likelihood of developing ganglion cysts in the affected areas. Occupations or hobbies that involve frequent use of the wrist also increase the risk of ganglion cyst formation. Even if the cyst is treated, there is a high risk of recurrence.

Diagnosing Ganglion Cysts

In most cases, a physical examination by a doctor is sufficient for diagnosis. Imaging techniques such as X-ray, ultrasound, and magnetic resonance imaging (MRI) may be used to rule out other conditions that could be mistaken for a ganglion cyst. These methods can also reveal hidden cysts.

Treating Ganglion Cysts

Ganglion cysts are typically painless and do not require treatment. Therefore, an observation and wait-and-see approach is often applied since many cysts resolve on their own. However, if the cyst causes pain or restricts joint movement, different treatment methods are necessary. Activities or joint movements can contribute to the growth of the cyst, so immobilizing the area temporarily with a splint is recommended. Immobilizing the area can shrink the cyst, relieving nerve pressure and reducing pain.

However, prolonged immobilization of the limb can lead to muscle weakness. Therefore, it should not be immobilized for longer than the recommended period. In cases where the cyst does not regress with immobilization, aspiration (draining the fluid with a needle or syringe) may be performed. Aspiration is a procedure performed on an outpatient basis. To prevent the cyst from recurring, a dose of cortisone may be injected into the site where the cyst was drained. However, there is no definitive evidence that cortisone injections prevent the recurrence of the cyst. Aspiration is recommended before surgery as it is a less invasive procedure. However, ganglion cysts often recur after aspiration, requiring surgery.

Surgery is done with anesthesia based on cyst location and surgeon’s preference. A small-to-medium incision is made at the site of the cyst to remove it.

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