Ganglion cysts are lumps under the skin found on the hand or wrist or around other joints such as ankles and knees. Ganglion is caused by the lining of joints and tendons pushing out from its normal position and becoming filled with fluid. The reason they form is not known.
Ganglion cysts usually do not cause problems unless they become so large that they impede joint function or become painful. They are found most frequently in women between 20 and 40 years old and in most cases, they are entirely harmless and are not cancerous.
A physical examination is all that is usually required to diagnose a ganglion. Typically, ganglion cysts are rounded, firm and have a smooth surface. They can be felt underneath and separate to the overlying skin and are usually mobile and painless. A light shone onto the ganglion illuminates it whereas a solid mass won’t light up. They can fluctuate in size as the amount of fluid contained within them can vary: following activity they can become larger, fluid may be reabsorbed into the body and then return to refill the ganglion, or the cyst may spontaneously burst or leak.
To confirm diagnosis your doctor may draw some fluid out of the cyst using a syringe and needle, under local anaesthetic. The contents of a ganglion can be yellow or clear. An ultrasound examination can also detect whether the cyst is solid or caused by a blood vessel.
Treatment of ganglion is not usually required at all. They often go away by themselves over time, but this could take years. Around 50% resolve spontaneously within 10 years. This type of approach is known as ‘watchful waiting’.
There are two main treatments for problematic ganglion: aspiration and surgery
Aspiration is when the fluid from the ganglion is drawn out using a needle and syringe. This is unlikely to be curative but will reduce the size of the ganglion. In fact, according to the NHS website on ganglion, half of ganglion cysts treated with aspiration will recur. After the 3rd or 4th aspiration treatment it is less likely to pop up again. Some doctors will recommend a steroid injection into the cysts following aspiration, but the benefits of this are not clear.
Surgical removal of ganglion is possible in some cases, depending on its location and how close it is situated to blood vessels, nerves and tendons. The ganglion cyst should be removed entirely otherwise it may come back. The procedure is usually carried out as an outpatient unless complications are anticipated.
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