A ganglion is a common cyst which is usually benign, and which is caused following small tears in the joint's, tendon's or bone' sheath. As a result a "balloon" is formed, filled with liquid, expanding and contracting according to the stress caused by the joint's operation.
The ganglion lump causes, for the most part, a sensation of discomfort. Occasionally it might cause pain, when it creates pressure on a nerve, and limitation of the joint's movement.
The highest frequency for the appearance of a ganglion in an upper limb is at the back of the wrist. Second to it is a ganglion located in the area where we feel the pulse, on the thumb's side of the wrist.
Women in their third and fourth decades tend to suffer from this phenomenon more than others, though it also exists in men and children.
Trauma and erosion of the joints may be a cause for the future development of a ganglion. Also, the disease of osteoarthritis, a degenerative inflammation of the joint, increases the risk for the development of a ganglion.
Diagnosing the Ganglion
Diagnosis is done by the orthopedist by feeling the area with his hand, a procedure which might cause discomfort and complains by the patient.
Occasionally diagnosis is done by drawing liquid from the cyst in order to identify the liquid's nature a procedure which causes aw temporary reduction of liquid volume in the cyst and a reduction in pain, or by Ultrasound or MRI imaging.
X-Ray Radiography of the ganglion serves to rule out other findings and to find an inner ganglion, which is hidden within the joint and which may cause chronic pain.
Treating the Ganglion
Conservative treatment -
A ganglion which causes no pain or restriction of movement is treated by reducing the joint's activity stress, sometimes by a splint to support the area. A conservative treatment is recommended as an initial treatment with a recommendation for further follow-up, especially when the ganglion appears in children.
Pharmaceutical treatment -
If giving the ganglion area a rest is ineffective, it is possible to draw out the liquid using a needle and inject steroids which may prevent its return, but in many cases the liquid will return and fill the ganglion cyst space once more.
Surgical treatment -
The cases in which the decision is made to conduct a surgical intervention are when the ganglion does not retreat following the conservative treatments and continues to cause pain, day-to-day impairment or an aesthetical problem due to its size.
The type of surgery and anesthesia is decided according to the ganglion's location. In many cases this is local anesthesia with an arterial tourniquet preventing blood flow to the cut's location. The arterial tourniquet may cause a sensation of pressure.
An operation under full anesthesia is always conducted in the case of a ganglion located in the area where we feel the pulse, at the thumb's side of the wrist, because its location on the artery is a risk factor for injury.
The chance for the ganglion's return is lesser following its surgical removal.
Dr. Alon Covo