Brief overview
- Treatment: If necessary, only observation and physiotherapy, otherwise surgery or aspiration; under no circumstances self-treatment by “smashing”.
- Symptoms: Prallelastic bulge of a few millimeters to a few centimeters in diameter, possibly pressure pain, restriction of movement or numbness, but often without discomfort
- Causes and risk factors: Not exactly known; connective tissue weakness and risk factors such as joint disease or increased joint stress likely play a role
- Diagnosis: Patient interview, physical examination, possibly imaging and fine needle aspiration
- Prognosis: Mostly favorable course, but ganglions often recur.
- Prevention: avoid overloading of joints, relaxation exercises
What is a ganglion?
Ganglia are connected to the joint via a kind of grommet, which is why they can hardly be moved. Today, physicians therefore speak more precisely of a “synovial cyst”. (Synovia is the name for the joint fluid).
Where can a ganglion develop?
Ganglions occur most frequently on the hand (in about 65 percent of cases): Here, the ganglion develops especially on the back of the hand. Sometimes the fingers or wrist are also affected. Less often, a ganglion develops on the hip, knee, feet or spine.
More rarely, a ganglion occurs on the tendon sheaths (tendinogenic). In this case, it is also called a tendon sheath ganglion. Another special form of ganglion is the so-called intraosseous ganglion, which forms in a bone. It therefore bulges inward instead of outward.
How is a ganglion treated?
If a ganglion does not cause any symptoms, it does not necessarily need to be treated. Some ganglions disappear on their own after some time.
However, many patients find a ganglion cosmetically disturbing or it causes them discomfort (such as pain during certain movements, limited mobility). Treatment is then advisable. Basically, there are three ways to treat a ganglion: conservative treatment, aspiration and surgery.
Which method is used in each case depends on several factors, such as the location of the ganglion. The patient’s wishes are taken into account when planning the ganglion therapy.
Can you treat a ganglion yourself?
Various home remedies that are supposed to make a ganglion disappear can be found in different sources, such as treatment with pork fat and a white cabbage leaf. There is no medical description of the effect – under certain circumstances, the effect is based on the quite beneficial immobilization of the joint, which is also used as a conservative treatment measure.
Bandaging and massaging of the ganglion probably have a similar effect, which cannot be proven with certainty – massages by a physiotherapist, however, also often cause a reduction or disappearance of the ganglion.
There are also reports that ganglions have disappeared after several weeks of “treatment” with homeopathic globules or Schuessler salts. There is no scientific or orthodox medical proof of the effectiveness of these alternative healing methods, just as there is no proof for “discussing” the ganglion or other measures.
Conservative treatment
A ganglion that does not affect the affected person is usually simply observed by the physician at first. It is possible that the ganglion will regress spontaneously or with the help of physiotherapy. Immobilization can prevent it from growing larger.
It is also important to avoid incorrect loading of the affected joint. After about three months of conservative treatment, the doctor will in most cases discuss with the patient how the therapy should be continued.
Aspiration
Aspiration, which the physician may have used to make a diagnosis, can also be used therapeutically. In this form of ganglion treatment, the physician punctures the supra-leg with a fine hollow needle and aspirates the contained fluid (needle puncture). However, new fluid usually accumulates within a short time (ganglion recurrence).
Another option is to inject the enzyme hyaluronidase into the ganglion. It breaks down the main component of the fluid it contains (hyaluronic acid). Then the doctor aspirates the fluid by means of aspiration.
Surgery
Surgical removal of a ganglion is considered very promising when performed by an experienced specialist. In this procedure, the surgeon removes the ganglion and tries to close the joint so that no more fluid escapes. In principle, ganglion surgery can be performed openly (through a larger incision in the skin) or minimally invasively (arthroscopically). As a rule, only a local or regional anesthetic is required for ganglion surgery.
After the operation, the operated area should initially be rested and immobilized. The patient may wear a splint for some time. Accompanying physiotherapy often helps to prevent the joint from stiffening.
Complications of ganglion surgery
Complications occur in one in ten open surgeries. Arthroscopic surgery and aspiration procedures, on the other hand, cause problems much less frequently, at four and two percent, respectively. Vascular (bleeding) and nerve injuries (numbness, paralysis) are particularly common in open surgery. In addition, there is a risk of infection, wound healing disorders and the development of Sudeck’s disease (a chronic pain syndrome). In addition, as after any surgery, a (small) scar remains.
What to do if the ganglion bursts?
In many cases, a ruptured ganglion heals on its own. However, there is a risk that the wound will become infected or that the ganglion will reappear. It is best to see your doctor with a burst ganglion to avoid complications.
Symptoms
Affected people usually notice a bump on the wrist or back of the hand, less often on other parts of the body. It is possible for multiple ganglions to develop.
The “lump” at the wrist or other parts of the body is typically turgid. It has an average diameter of a few millimeters to two centimeters. However, there are also ganglions that grow up to eight centimeters in size. Some remain so small that the affected person does not even notice the protrusion and it is only discovered by chance.
If a ganglion presses on tendons, it is possible that it will squeeze them and possibly cause inflammation (tendonitis) due to the permanent stress.
Numbness, tingling or weakness in the hand are possible indications that the ganglion is “pinching off” a nerve. The nerves are often affected in so-called ring ganglia. These are small bones on the ring ligaments of the fingers, which may make bending and stretching difficult.
But also wrist, or foot (back) are susceptible to depressed nerves and vessels. The pressure on vessels may cause bleeding. It is also possible for infections to spread in the fluid-filled space of the ganglion.
Causes and risk factors
The exact causes of a ganglion are not yet known. It is likely that several factors play a role in the development of a ganglion. For example, a weakness of the connective tissue:
In some cases of connective tissue weakness, in conjunction with overloading of the joint, synovial fluid escapes from the joint cavity and collects in the surrounding soft tissue. This is how a ganglion develops, experts suspect.
Risk factors
Risk factors for a ganglion include:
- Increased joint stresses, such as those caused by repetitive small injuries to the capsule and ligamentous apparatus
- Disturbances in the biomechanics of the joint or tendon
- @ Joint diseases and rheumatic diseases (such as osteoarthritis, lupus erythematosus, gout)
About ten percent of patients have previously injured themselves in the area of the ganglion. In addition, in a ganglion, connective tissue cells (fibroblasts) probably stimulate the production of synovial fluid. Their components hyaluronic acid and so-called mucopolysaccharides form a viscous fluid, which then accumulates in the ganglion.
Examinations and diagnosis
If you suspect a ganglion, consult an orthopedist or surgeon. He or she may rule out underlying conditions such as osteoarthritis as the trigger of the lump. It is best to contact a doctor who specializes in the affected area of the body, such as a hand surgeon for a ganglion on the hand.
To clarify the suspected ganglion, the doctor usually proceeds as follows:
Taking the medical history: In a conversation with the patient, the doctor inquires about the exact symptoms as well as any injuries and underlying or previous diseases. Possible questions the doctor may ask in this history-taking interview include:
- When did you first notice the swelling?
- Does the swelling affect the mobility of the affected body part or does it cause pain?
- Have you ever injured yourself in the affected area?
- Have you had similar “lumps” before?
Physical examination: Then the doctor examines the swelling to assess it more closely. A ganglion feels turgid, similar to a firm rubber ball. It can be moved only slightly because of its attachment to the joint or tendon sheath. Unlike highly inflammatory processes, the affected region is neither overheated nor red. The physician may take photographs for documentation.
In addition, he will check blood flow, motor function and sensitivity in the area of the affected body region. For example, he will detect movement restrictions caused by the ganglion, circulatory problems and nerve damage. It is also possible to “transilluminate” the swelling: by shining a light source through the side of the ganglion, the doctor determines whether the interior is fluid (indicating a ganglion or cyst) or solid.
Fine needle aspiration: For diagnostic and therapeutic purposes, the physician punctures the ganglion with a very thin, hollow needle under ultrasound control to extract fluid from inside. This usually thick, clear fluid is then examined by a pathologist in the laboratory. This helps rule out inflammation or malignant processes. Draining fluid from the ganglion causes it to visibly shrink. In most cases, however, this is not a permanent solution.
Course of the disease and prognosis
A ganglion is a benign protrusion with a favorable course. It often regresses spontaneously, but also enlarges in some cases. In most cases it does not cause any discomfort. Depending on its location, however, it causes (pressure) pain or numbness or restricts the mobility of the affected joint.
On the other hand, after aspiration treatment, half of the patients develop a supra-leg again.
Prevention
To prevent recurrences, risk factors for ganglions should be reduced and the muscles should be repeatedly relaxed and loosened. This prevents overstraining, which may promote a ganglion.
In general, however, it is difficult to prevent a ganglion.
