Ganglion cysts are small and common benign soft tissue tumors filled with jelly-like fluid from the joint membrane or tendon sheath. They are most commonly seen in the wrist, and less commonly in the ankle and foot. Ganglion cysts originate from the joint capsules and ligaments that connect the bone structures. They are masses characterized by the filling of fluid similar to joint fluid into the sac after the herniation of this ligament tissue. Ganglion cysts are not malignant cancerous tissue and do not turn into malignant tissue.
What Causes Ganglion Cysts?It is not known exactly why ganglion cysts form. However, it is thought that past trauma and straining of these ligaments play a role in their formation. Especially professionals who require intensive use of the wrist and fingers are at risk. In addition, it is more common in women and the middle-aged group.
What Are the Symptoms of Ganglion Cysts?Ganglion cysts are the most common benign formations of the wrist. They are mostly seen on the wrist and the back of the hand. Their shapes are mostly round, rarely oval. Their size can be too small to be noticed, and can reach up to 2.5-3 cm. After the cyst forms, it grows significantly over time. For this reason, some patients apply to the hospital with the fear of cancerous tissue. After seeing the mass, the patient may notice that it sometimes grows and sometimes shrinks. The patient often states that the mass grows when he works hard and strains his joints, and shrinks when he rests. The reason for this is that the increased joint pressure increases the fluid in the cyst when the cyst area is strained and tired.
How is a Ganglion Cyst Diagnosed?A ganglion cyst is usually noticed by the patient when it grows. It has regular borders, is round and has a somewhat hard consistency under the skin. It becomes painful when it presses on the surrounding nerves. The reason for the patient to see a doctor is usually the growth and pain. When the patient sees a doctor, examination and the history of the formation of the mass are usually sufficient for diagnosis
In case of doubt, a soft tissue ultrasound or MRI may be required for differential diagnosis. In some rare cases, the cyst may form in deeper tissues and may not be visible from the outside. In such cases of unexplained wrist pain, the doctor may find it necessary to have an MRI.
How is a Ganglion Cyst Treated?There are important points to look at before treatment. These are the location of the mass, the size of the mass, whether it is painful or not, and its effect on joint movements. Doctors usually recommend follow-up for a small and painless mass on the wrist. This is because approximately half of ganglion cysts heal on their own. After explaining to the patient that the mass does not pose a threat, information is provided about the possible progression of the disease.
If the mass grows or becomes painful, the patient is asked to come back. In the meantime, a wrist brace is given to the area where the cyst is located to rest and movement is restricted. The follow-up period varies from patient to patient, but can be considered as 1.5-2 months. Aspiration (withdrawal of the fluid in the mass with the help of a syringe) can be tried for masses that grow or become painful over time. The advantage of aspiration is that it can be easily performed in outpatient clinic conditions.
However, cysts reduced with aspiration method have a very high probability of recurrence. The patient should definitely be informed about this issue and it should be explained that surgical intervention may be required if no response is received. Cysts that form adjacent to the nerve and put pressure on the nerve cause pain. Aspiration applied to painful cysts carries the risk of damaging the nerve tissue. Similarly, most cysts that form on the front of the wrist are adjacent to arteries. Therefore, aspiration should not be applied to these cysts. On the other hand, attempts to burst the cyst unconsciously or drain it with a needle by the patient or people around should definitely not be performed due to the risk of infection and serious damage to the surrounding tissues.
How is Surgery Performed in Ganglion Cysts?Limited anesthesia is usually sufficient in surgical procedures. However, if the cyst is large and deep or if the patient is concerned about local anesthesia, general or mask anesthesia can be applied. The surgical procedure is performed with a skin incision made according to the size of the mass. During the removal of the mass, the entire cyst, including the deep part, must be removed. Partial cyst excisions due to comfort problems or lack of experience during the surgical procedure carry a risk of recurrence. However, it should not be forgotten that there may be a 5% risk of recurrence even after the most appropriate surgical procedures.
However, if a patient with a ganglion cyst on the wrist is first recommended by the physician, the joint is asked to rest and a wrist brace is given. If the mass continues to grow despite this treatment, if it creates a cosmetic problem for the patient, or if the painful cysts do not regress as a result of follow-up, surgery is recommended for the cyst.