Symptoms
A ganglion cyst or ganglion is a benign, round to oval, soft swelling that is common in the wrist and less common in other joints. Ganglions range in size from millimeters to about two centimeters. About 70% of them occur on the dorsal side of the wrist, that is, on the dorsum of the wrist. Less commonly, they are also observed volarly (palmar), i.e., on the inner side of the wrist. Ganglions are not inflamed or reddened. Complaints do not necessarily occur. If ganglions press on a nerve, they may cause pain, sensory disturbances (paresthesias), numbness, limitation of mobility, and muscle weakness. These disorders can affect the arm, wrist and hand. Patients may be worried because they fear that it is a cancer. The supra-leg may also be bothersome for aesthetic reasons.
Causes
Ganglions develop near tendons and joints. They are filled with a thick, clear tissue fluid composed mainly of hyaluronic acid. Ganglions are connected to the joint capsule or tendon sheath by a stalk. Movement and activity promotes the passage of gelatinous fluid into the cyst. In English, ganglions are referred to as. However, they are not true cysts because the wall is composed of layers of collagen rather than a cellular epithelial layer. The term tumor is also used, but in our view it should be avoided when talking to patients. The ganglion is not a cancer. Various explanations exist for its development, for example, a strain on the joint structures and a degeneration of the connective tissue. An inflammation, on the other hand, is not present. Hyper ganglions occur more frequently in young women and after the age of 20.
Diagnosis
Diagnosis is made under medical care based on the patient’s history, physical examination, with transillumination, and possibly with imaging. Aspiration can be used to determine whether fluid is present in the ganglion. Other diseases and tumors must be excluded.
Nonpharmacologic treatment
If the ganglion does not cause discomfort and is not bothersome, therapy may not be necessary. Ganglions can often disappear on their own. Temporary immobilization with a splint may reduce the size and relieve symptoms. Aspiration can be used to remove the fluid, which reduces pressure and relieves discomfort. However, the risk of recurrence is high. With surgery, surgical removal of the cyst is possible. Recurrences are less frequent after surgery. The so-called “Bible method” involves hitting the ganglion with a large book – such as a Bible – in the hope that it will burst. This method for self-treatment is controversial because of the risk of injury.
Drug treatment
Drug therapy with an injection of glucocorticoids (e.g., methylprednisolone), sclerotherapeutics, or hyaluronidase is controversial. Short-term analgesics such as acetaminophen can be taken to treat the pain. Local therapy with topical NSAIDs or similar externals can be tried. Antiepileptic drugs such as pregabalin, among others, are also available for the treatment of neuropathic pain. They could be administered temporarily for severe symptoms.
