A ganglion, colloquially known as a ganglion, is a swelling under the skin. It usually occurs on a tendon sheath or joint capsule of the hand, but can also be found on the foot and sometimes the knee.
What is a ganglion?
Graphic illustration of a ganglion and its anatomy. A ganglion is a cyst, which is a fluid-filled chamber in the tissue located under the skin. The cyst is associated with a joint capsule or with a tendon sheath located under it. The ganglion has the name of overbone (with “leg” in the old sense of bone) because it appears as a swelling on the outside. The swelling is called a soft tissue tumor by physicians, although this tumor is harmless. The fluid in the cyst is formed from hyaluronic acid. Ganglion is often found on the hand, less commonly on the foot or knee.
Causes
Exactly how a ganglion develops is not yet fully understood. One cause that is considered possible is tears in the tendon sheath or joint capsule. Such tears can occur when increased joint fluid is produced. When the amount of fluid becomes too great, it penetrates through the tear into the surrounding tissue, where it forms a cyst. This ganglion is then further associated with the site of origin, i.e., the tendon sheath or joint capsule. Why there is increased production of synovial fluid is unknown. Congenital disorders, overload due to movements or overstimulation are suspected. Hormonal causes cannot be ruled out either, as women are about three times more likely to have a ganglion than men. If a ganglion has already formed, it usually becomes enlarged with movement.
Symptoms, complaints and signs
Most often, ganglions occur on the back of the hand, wrist, or fingers, but in rarer cases they can occur on the back of the foot, knee, elbow, or shoulder. Those affected first notice a bump. This typically takes the form of a bulging nodule or an ovoid-oval swelling. A ganglion can be up to two centimeters in size. However, some are only a few millimeters in size and are discovered by accident or go completely unnoticed. It is also possible for several ganglia to form next to each other. If the ganglion has a certain size, it is also visible to others. Often, ganglions do not cause any pain at all in the affected person. In other cases, however, severe pressure pain can occur, which can also radiate to other areas. For example, a supra-leg at the wrist can also make itself felt through elbow pain. This can massively restrict the affected person’s freedom of movement. Larger ganglia can also squeeze nerve tracts and vessels. This can cause numbness and tingling in the limbs. The pressure on the vessels can also lead to bleeding and, subsequently, infection.
Course
The course of the disease in a ganglion can manifest itself in different symptoms. In any case, the ganglion can be recognized visually as a swelling or sometimes can only be palpated. The degree of pain is very differentiated in people who have a ganglion. For example, in some people it only causes pain when it is subjected to a compressive stress, while other affected persons experience a clear continuous pain. If the ganglion has formed in the area of nerve pathways, then this can also lead to a numb feeling. It also happens that the ganglion does not appear as a ganglion, but develops on the joint and is not visible from the outside. In this disease process, symptoms often appear in the form of joint pain caused by the ganglion.
Complications
The ganglion primarily causes severe swelling and pain. The pain is stabbing and can likewise spread to other regions of the body, causing severe pain and other discomfort. It is not uncommon for the joints to feel numb and for the patient to experience sensory disturbances and restricted movement. As a rule, a ganglion severely restricts the daily life of the affected person and reduces the quality of life. The pain can occur either in the form of pain at rest or as pressure pain. Pain at rest can lead to sleep disturbances and a general irritability of the patient. In addition, they usually have a negative effect on the patient’s psyche.Complications usually do not occur during treatment. Treatment also only needs to take place when there is real discomfort from the ganglion. Exercises and therapies are mainly used. A ganglion without symptoms is usually not treated and still does not lead to complications. In severe cases, treatment can also take place with the help of medication.
When should you see a doctor?
If an unusual swelling or growth appears on the hand, foot, or knee, a checkup with a primary care physician should be initiated. If this swelling suggests that there is fluid in it, it could be a ganglion. Since treatment should be given, a physician’s clarification of the observation is necessary. If the changes in the appearance of the skin cause difficulties in movement or everyday activities can no longer be performed as usual, a visit to the doctor is necessary. If numbness or sensory disturbances occur in the affected region, a physician should determine the cause. In case of pain or discomfort, a doctor is needed before taking painkilling medication. If the growth on the extremities enlarges or the impairments increase, a doctor should be consulted as soon as possible. If discomfort of the joints occurs or if there is one-sided physical strain, the patient is at risk of further illness if he or she does not seek medical treatment. If there is a feeling of tension or pressure, emotional stress or irritability, a doctor should be consulted. If there is a stressful experience or if the usual performance decreases, it is advisable to ask a doctor for help.
Treatment and therapy
A ganglion does not always cause pain or other discomfort. If this is the case, therapeutic measures should initially be avoided, because a ganglion often regresses spontaneously. If, on the other hand, the ganglion is associated with pain or with other discomfort, such as restrictions in movement function, conventional therapy is initially performed. Various procedures are used here. If the pain is only mild, physiotherapy treatment can help. Another option is to remove the fluid from the cyst by puncture. To help the swelling go down, cortisone injections may be used. Another option for drug treatment is injecting hyaluronidase. This causes the hyaluronic acid in the cyst to break down and the ganglion to regress. If these procedures do not work or the pain is too severe, surgical removal of the ganglion may be necessary. During surgery, not only is the cyst removed, but the tear that caused the ganglion to form is closed.
Outlook and prognosis
The ganglion has a favorable prognosis. Spontaneous healing is documented in many patients because the synovial fluid formed can be removed by the organism at any time. This results in regression of the ganglion and freedom from symptoms for the patient. Late effects are not to be expected. The range of motion is completely restored, so that the patient does not have to expect any impairments. Despite a possible spontaneous healing, a ganglion can form again at any time during the patient’s life. In these cases, the prognosis remains positive. If the ganglion does not heal on its own, only medical treatment can bring about relief. In addition, without therapy, there is a risk of the swelling increasing in size in the further course. This results in an increase in discomfort and triggers a restriction of movement possibilities. Regardless of the choice of treatment method, a rapid recovery occurs under optimal conditions. If no further complications occur, the patient is discharged from treatment within a few days or weeks. A follow-up visit is usually scheduled after a few months to check whether there has been any re-accumulation of joint fluid and mobility has been fully restored. Possible poor posture or incorrect loading is checked and corrected immediately if possible.
Prevention
Although it is not yet fully understood why a ganglion develops, the relationship to incorrect joint loading is obvious.Exercises that relax the joints are therefore recommended for prevention. This is particularly important if the joints are subjected to heavy loads, for example when working at a computer. With the help of stretching exercises and loosening of the arm and hand muscles, which also involves functional movement of the joints, a ganglion can be prevented.
Aftercare
If the ganglion is removed surgically, the wound must be checked regularly in the first few days afterward. This will allow early detection of inflammation or swelling. The application of an elastic bandage can usually prevent bleeding and fluid accumulation in the wound area. Immobilization of the affected joint is not necessary in every case, but it can reduce pain in the first days after the operation. If a ganglion is removed from the flexion side of a joint, a splint makes sense. If the wound heals well, the dressing is renewed two to three times in the first week and the stitches are removed between the 10th and 14th day. One to two days after removal of the stitches, a bandage is usually no longer needed. After surgery, full weight should be placed on the joint slowly and gradually. If this is forced too quickly, it can cause the ganglion to reappear and cause swelling and pain. Regular baths of the affected area in cold or lukewarm water have a beneficial effect. Rubbing the surgical scar thinly with a fatty ointment softens the tissue. In most cases, physiotherapy or occupational therapy is not necessary. As a rule, the inability to work is three to four weeks.
What you can do yourself
The ganglion can be treated by the affected person himself, insofar as the ganglion does not cause pain or the movement of the affected person is not restricted. In this case, surgical removal is then not necessary. However, this should be clarified by a physician in advance. The affected person can treat the ganglion with healing clay. Healing clay consists of minerals and is either applied directly to the ganglion or the healing clay is first heated and then applied. Both options should provide relief from the ganglion. Alternatives to healing clay include poultices with comfrey ointment or arnica ointment. Additionally, the ganglion can also be treated with horse ointment. If the ganglion does not improve, it can also be treated with cortisone and painkillers prescribed by a doctor. In combination with temporary fixation of the affected area, this can lead to improvement. If these measures do not lead to any improvement, then a doctor should be consulted. If the ganglion does not cause any discomfort at all, then it cannot be treated. It is possible that it will burst during an impact, and the escaping fluid from the cyst will then be absorbed by the body. The ganglion is thus removed and no further steps are needed.
