Ganglion Cyst

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

A ganglion cyst is a noncancerous lump, typically found along the tendons or joints of the wrists or hands, although they can also occur in the ankles or feet. These cysts are filled with a jelly-like fluid and can vary in size.

Aetiology

The exact cause of ganglion cysts is unknown, but they are believed to develop when synovial fluid leaks out of a joint or tendon sheath and collects in a sac. Factors that may contribute to the formation of ganglion cysts include:

• Joint or tendon irritation or mechanical changes, such as repetitive use or trauma
• Arthritis, particularly in the hands and wrists
• Previous joint or tendon injuries

Pathophysiology

The pathophysiology of ganglion cysts involves:

• Herniation of the synovial membrane, leading to the formation of a cystic structure
• Accumulation of synovial fluid within the cyst, which causes it to expand
• The cyst wall is made of dense connective tissue, which may be connected to the underlying joint or tendon sheath
• The cyst can fluctuate in size, often becoming more prominent with activity and less so with rest

Risk Factors

• Women are more likely to develop ganglion cysts, particularly between the ages of 20 and 40
• Individuals with osteoarthritis, particularly in the fingers, are at a higher risk
• Previous injuries to the joints or tendons
• Repetitive stress on the joints, especially the wrist, due to activities or occupations involving heavy use of the hands

Signs and Symptoms

The signs and symptoms of a ganglion cyst include:

• A visible lump, often on the back of the wrist, palm, or fingers, that may fluctuate in size
• Pain or discomfort, particularly if the cyst presses on a nerve
• Restricted range of motion or weakness in the affected joint
• In some cases, the cyst may be asymptomatic and discovered incidentally

Investigations

Specific investigations to diagnose a ganglion cyst include:

• Clinical examination: Palpation of the lump, which is usually soft and movable.
• Imaging studies:
  • Ultrasound: Used to confirm the cystic nature of the lump and to differentiate it from solid masses.
  • X-rays: Typically used to rule out other conditions such as arthritis or bone tumours.
  • MRI: Occasionally used in complex cases to assess the relationship of the cyst to surrounding structures.
• Aspiration: A needle may be used to aspirate the fluid from the cyst, which is usually clear and jelly-like. This can confirm the diagnosis and provide temporary relief.

Management

Primary Care Management

• Observation: If the cyst is asymptomatic, monitoring without intervention is often recommended, as many ganglion cysts resolve spontaneously.
• Aspiration: Fluid may be aspirated from the cyst using a needle to reduce its size. However, cysts often recur after aspiration.
• Pain management: Analgesics such as paracetamol or NSAIDs can be used to relieve pain if the cyst is causing discomfort.
• Activity modification: Avoiding activities that exacerbate the cyst or cause discomfort, particularly repetitive wrist movements.

Specialist Management

• Corticosteroid injection: May be used after aspiration to reduce inflammation and the likelihood of recurrence.
• Surgical excision: Considered for persistent or symptomatic cysts that do not respond to conservative management. Surgery involves removing the cyst and part of the joint capsule or tendon sheath from which it arises.
• Postoperative care: Includes immobilisation and physiotherapy to restore function and reduce the risk of recurrence.

References

1. NHS (2024) Ganglion Cyst. Available at: https://www.nhs.uk/conditions/ganglion-cyst/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Ganglion Cyst. Available at: https://cks.nice.org.uk/topics/ganglion-cyst/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Ganglion Cyst: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h2942 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Ganglion Cyst. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/ganglion-cyst/ (Accessed: 24 June 2024).

Back to Top