Ganglion Cyst

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Ganglia (ganglion) are clusters of nerve cell bodies located throughout the entire body. They are part of the peripheral nervous system as they are divided into two broad categories, which are the sensory ganglia and the motor ganglia:

  • Sensory ganglia – The sensory ganglia are ovoid in shape and contain oval cell bodies with nuclei that form in a circular pattern.
  • Motor ganglia – In the spine, the motor ganglia form a long chain from the base of the skull down to the tail end of the spine. Motor ganglia contain irregular-shaped cell bodies.

Furthermore, the motor ganglia help receive information from the central nervous system to regulate and control involuntary movements and functions. Motor ganglia also send information to the central nervous system from the heart and lungs. In cases of sensory ganglia, they send sensory information to the central nervous system. This information includes touch, smell, taste, sound, and visual stimuli.

A ganglion cyst is a fluid-filled lump found right under the affected skin. It is commonly located over a joint or in a tendon in the hand or wrist. The ganglion cyst forms when there is a small tear (herniation) in the sleeve of thin tissue covering a joint or tendon. The tissue gradually bulges and forms a sac. Fluid from the joint then leaks into the sac and causes a visible swelling. The name of the ganglion cyst also changes with its place on the body:

  • Dorsal wrist ganglion cyst – This condition is known to appear on top of the wrist.
  • Volar wrist ganglion cyst – Volar ganglion cyst is found on the palm side of the wrist.
  • Mucoid cyst – This type of ganglion cyst forms on a finger. These usually occur in middle-aged or older people.

Most ganglion cysts appear and disappear on their own without treatment. Some cysts may become painful or tender, interfere with regular hand function, or have an objectionable appearance. Therefore, performing a conservative treatment is essential to recover a ganglion cyst (with an average recovery estimation of eight weeks).

Causes & Symptoms of a Ganglion Cyst

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The causes of a ganglion cyst remain unknown; however, some theories indicate that a cyst may develop after something injures a joint, allowing the tissue to suddenly leak or bulge out, thus forming a ganglion cyst.

Most studies agree that ganglion cysts develop from mesenchymal cells at the synovial capsular junction as a result of the continuous micro-injury.

Repetitive injury to the supporting capsular and ligamentous structures appears to stimulate fibroblasts to produce a hyaluronic acid, which then produces a jelly-like material commonly found in ganglion cysts.

Ganglion cysts normally appear at specific joints – using the joint near the cyst may increase swelling and worsen any discomfort you feel. Ganglion cysts therefore develop in the following areas:

  • Finger – Near any finger joint close to your palm or below the fingernail.
  • Wrist – Ganglion cyst may appear on the front or back of the wrist.
  • Foot – The cyst can also show up neat your ankle or your toes.

A ganglion cyst is normally soft, around 0.5 to 1.0 inch in size, and does not move out of place. When it is connected to a tendon, you may feel weakness in the affected finger.

When the cyst is on your foot, you may have difficulty fitting into shoes because of the irritation between the lump. Because the fluid-filled lump presses on the nerves passing through the joint, you may feel ongoing pain and discomfort in that joint, especially after considerable movements that put it through either severe or constant pressure.

However, about one out of every three ganglion cysts shows no symptoms other than the unsightly bulge growing out of a joint. In addition, there can be one large cyst or several smaller ones. While a cluster may appear more threatening because there are multiple cysts, a common stalk within a deeper tissue typically connects them all.

This type of cyst is not harmful and accounts for half of all soft-tissue tumors of the hand. In some cases, some ganglion cysts are so small that they do not cause obvious physical swelling, however, they still tend to cause pain. These are known as occult ganglions.

Who gets a Ganglion Cyst?

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Anyone can develop a ganglion cyst on their finger, wrist, or foot. However, the following risk factors below can increase your chances of having one of these cysts:

  • Age – Those between the ages of 20-50 years are the most susceptible to experiencing ganglion cysts. Rarely, ganglion cysts can occur in children younger than 10 years.
  • Gender – Women are much more prone to develop ganglia cysts; three times more than men.
  • Arthritis – Having arthritis in your hands can increase your risk of getting a ganglion cyst. Patients with arthritis often get a ganglion cyst near their fingertips. Also, having osteoarthritis can elevate the risk for ganglion cysts.
  • Past injuries – Studies show that a joint (such as tendonitis from overusing your wrist) could lead to a ganglion cyst developing in the future.

How Does a Ganglion Cyst Affect You? How Serious is it?

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Most cysts do not need treatment, however, others must be surgically removed, such as a ganglion cyst. During a ganglion cyst removal, your doctor removes the cyst capsule or stalk to fully remove the cyst.

As with any other type of surgery, ganglion cyst removal can cause infection. You may also experience an allergic reaction to the anesthesia used in the removal process, or to the stitches used to heal the removal area. Other complications within the ganglion cyst removal include:

  • Losing the ability to move the wrist normally.
  • Injuries to surrounding tendons, nerves, or ligaments.
  • Sensitivity around the scar tissue.

Most likely, you will recover rapidly and without difficulty after a ganglion cyst removal. However, this success rate can vary from person to person. Some patients may experience a recurrence within a year after successful surgical removal.

Recommended Treatment, Rehabilitation for a Ganglion Cyst

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During a diagnosis of a ganglion cyst, your doctor will usually perform a three-step process, which will include a physical examination, medical history, and additional imaging tests.

Firstly, your doctor will examine and locate the lump’s appearance and location (such as on the wrist or fingers) to verify the condition. Once it is found, he or she may press on the bump to see if it bothers you then shine a bright light on the lump to see if it is translucent.

In some cases, your doctor may order imaging tests to remove a sample from inside the lump (biopsy) for further analysis. In cases of occult cysts, your doctor may recommend an X-ray to learn more about what is causing your symptoms. He / she may also use an ultrasound to tell the difference between a solid mass and a cyst.

Most ganglion cysts go away without the need for treatment and some re-appear despite treatment. It may even take a long time to recover (between 12-18 months) for it to naturally disappear.

If it isn’t causing any pain, your doctor may recommend simply watching over the cyst and being patient before it goes away. However, if the ganglion cyst is causing many problems, your doctor will discuss doing one or a combination of the following conservative treatments:

 

Splinting

The area affected by the ganglion cyst is immobilized. A brace or splint will prevent further irritation caused when the joint moves. It will help reduce swelling and provide much more comfort.

Aspiration

The fluid is drained from the ganglion cyst by using a needle. Your doctor first numbs the area, then a needle is inserted into the cyst and all the fluid is emptied out. Because the entire cyst isn’t removed, more than 80% of the time the cyst will fill with fluid again. Aspiration is not recommended on volar wrist cysts. There may be a risk of blood vessel damage and nerves in this area.

Surgical excision

A surgeon will cut out the entire ganglion cyst including the thin sleeve covering the tendon or joint. Excision greatly reduces the chance of the cyst coming back.

After a diagnosis and / or surgery has been done, physiotherapy may be further advised. A physiotherapist will design a specialized treatment program specific to your condition and goals, including the following:

 

Pain management

Your physiotherapist will help you identify and avoid painful movements and show you how to correct abnormal postures to reduce stress on the joint. He or she will recommend resting the wrist, hand, or foot short-term and applying ice to the area to help alleviate the pain. Your therapist may also apply a wrist brace to restrict wrist movement.

Manual therapy

Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and stretches to get your joints moving properly.

Range-of-motion exercises

You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and foot begin to move properly.

Strengthening exercises

Your physiotherapist will determine which strengthening exercises are perfect for you, depending on your specific areas of weakness. Therefore, your therapist will design an individualized home-exercise program to meet your needs and goals.

Patient education

Depending on the activities you plan on continuing, your physiotherapist will teach you different ways to perform actions, while protecting your affected joint. For instance, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.

Below are some exercise examples for you to try. The following exercises depend on the location of your injured joint, such as:

 

Hand flips

While seated, place your forearm and affected wrist on your thigh, palm down. Flip your hand over so the back of your hand rests on your thigh and your palm is up. Alternate between palm up and palm down while keeping your forearm on your thigh. Repeat this method 8-12 times a day.

Wrist flexion and extension

Place your forearm on a table, with your hand and affected wrist extended beyond the table, palm down. Next, bend your wrist to move your hand upward and allow your hand to close into a fist, then lower your hand and allow your fingers to relax. Hold each position for 6 seconds, then repeat 8-12 times a day.

 

Plantar fascia massage

Sit in a chair and cross the injured foot over the knee of the opposite leg. Then, place your fingers over the base of the toes of your injured foot and pull your toes toward your shin until you feel a stretch in the arch of your foot. With your other hand, massage the bottom of your foot, moving the heel toward your toes. Do this for 3-5 minutes gently, while pressing hard on the bottom of your foot as you become able to tolerate more pressure.

Alternative & Homeopathic Treatment for a Ganglion Cyst

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Most ganglion cysts recover naturally on their own. Although, there are other ways to boost your healing time with these home remedies below:

  • Non-steroidal anti-inflammatory medications (NSAIDs) – such as acetaminophen, naproxen, or ibuprofen can relieve a great amount of pain.
  • Compression – Regular use of warm compresses may increase blood circulation and promote fluid drainage.
  • Rest – Avoiding repetitive joint movements can relieve discomfort.
  • Supportive shoes – If you have ganglion cysts on your feet or ankles, it is recommended to wear loose shoes or modify the way you lace them. This may prevent your cyst to be touched by wearing tight shoes.

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