A ganglion (a gelatinous cyst) is a lump on the wrist that can be both small and painless, and large, painful and bothersome. Luckily, it is not a malignant tumor and it is not a dangerous change. Nevertheless, it cannot be underestimated - the appearance of any change on the wrist, even completely painless, should be consulted by an orthopedist. What are the causes and symptoms of ganglion? What is the treatment and is it necessary?
Ganglion( gelatinous cyst ) is a space limited by a connective tissue bag filled with a thick liquid, its consistency resembling a gel. It forms as an abnormal bulging of the joint capsule or tendon sheath - most often in the wrist area - hence patients often say that they have developed " wrist lump ". The synovial fluid flows into this "additional" space, retains there, accumulates and leads to the formation of a cyst, which becomes visible on the skin as a round, point thickening. Wrist ganglions are more common in women than in men, usually between the ages of 20 and 40.
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Ganglion - causes of formation
The reasons for the formation of ganglions are not clear. In some cases, they accompany injuries to the wrist structures - the ganglion is then formed at the site of a torn ligament.
However, in most cases, ganglions are not accompanied by other damage, and it is difficult to determine why they arose. It seems that microtrauma, repeated minor injuries, overload or local inflammation are important in their formation.
Ganglion - symptoms
Ganglion is a nodule-shaped lesion located under the skin - depending on its size, it may be barely perceptible or clearly visible. The size of the ganglion may change - periodically or e.g. after exercise, it may increase.
The change is quite cohesive, slightly shifting under the skin. Most often we deal with ganglions located on the back of the wrist. In most cases, the change is completely painless. For such patients, its presence is only a cosmetic defect, because the change itself is harmless.
In some patients, ganglion cancause pain, especially during movement, when it may put pressure on adjacent structures. A big shift can even restrict mobility. If the ganglion is close to the nerve branch, it can cause pressure on the branch. Then local sensory disturbances may occur, the pain may be constant, and muscle weakness may also appear.
Ganglion - diagnostics
The image of a ganglion is quite typical and for an experienced orthopedic surgeon, diagnosis is not a problem. However, in order to rule out other changes (e.g. neuroblastoma, sheath tumor) and to look for accompanying damage (e.g. scaphoid-lunate instability), it may be necessary to perform imaging tests. Depending on the needs, the doctor may order:
- X-ray examination
- ultrasound examination
- magnetic resonance imaging
Ganglion - treatment
If the diagnosis of ganglion is confirmed, the lesion is minor and does not cause any discomfort to the patient, no treatment may be undertaken. Observation is enough. Many of these changes resolve on their own - it is estimated that within two years of ganglion appearance, 90% disappear.
However, if the change bothers the patient - due to cosmetic reasons or causes ailments - treatment should be started. A less invasive, but effective method in less than 50% of cases, is the puncture of the cyst, removal of the fluid filling it, and injection of an anti-inflammatory drug - a corticosteroid. In some patients it improves, but you have to take into account that the risk of relapse is very high.
A more effective method is the surgical excision of the ganglion. This can be done with the so-called open method by making a cut on the skin directly above the ganglion. In some cases, arthroscopic treatment is possible. Then, only small, half-centimeter incisions are made on the skin, and the lesion is removed "from the inside". Rehabilitation is rarely successful in treating ganglions. It can relieve symptoms temporarily, but does not solve the problem.
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bow. Karolina Stępień, specialist in orthopedics and traumatology of the musculoskeletal system at the Carolina Medical Center
In most cases, ganglions do not require treatment, but their mere presence may be a cosmetic defect for the patient. In this case, the arthroscopic method is the preferred method of treatment, which leaves small, poorly visible scars. Nevertheless, the effectiveness of arthroscopic and open-label treatment in preventing recurrence of ganglionsis comparable.
Even if the lump you have noticed on your wrist matches the typical description of a ganglion and does not bother you at all, it is worth consulting your doctor about this change. It is necessary to exclude other, rarer, more dangerous changes in this area and diagnose for other accompanying damage.