A ganglion is a benign growth that occurs in the area of a joint capsule. Typically, a fluid-filled cyst forms that is easily visible and palpable from the outside. Such a joint cyst occurs particularly frequently on the hand or fingers. The elastic nodules often do not cause any discomfort, but they can also be accompanied by pain or a feeling of numbness. As a rule, ganglions can be treated well by conservative measures – but sometimes surgery is necessary.
A ganglion is not a ganglion
In common parlance, a ganglion is often also referred to as a ganglion. This is not technically correct, since a ganglion is a bony substance. Colloquially, however, it has become established to also refer to a ganglion as an overbone. In fact, a ganglion is called an exostosis.
Causes: Why does a ganglion develop?
A ganglion is one of the soft tissue tumors, although the term tumor simply describes the swelling that occurs as a result of the joint cyst. It is particularly common in the wrists or fingers, and less common in the knees or feet. Ganglions primarily affect younger people between the ages of 20 and 30 – women significantly more often than men. Exactly why a ganglion develops has not yet been clarified with certainty. Presumably, both spontaneous formation and formation due to chronic irritation are possible. The constant irritation of the tissue can lead to increased production of synovial fluid. If a tear develops in the joint capsule or tendon sheath as a result of the increased production, a cyst may form. This is a fluid-filled cavity that remains in communication with the joint capsule or tendon sheath via styliform outgrowths.
Symptoms: how to recognize a ganglion
Fluid accumulation usually causes a ganglion to develop a visible swelling that, in extreme cases, can reach the size of a cherry. In most cases, however, a ganglion is somewhat smaller. Characteristically, it appears in the form of a bulging, elastic nodule. Often a ganglion does not cause any discomfort, but sometimes it reacts sensitively to pressure. If the joint cyst exerts pressure on nerves or blood vessels, it can cause severe pain or numbness and tingling. Often, the pain also radiates into the surrounding tissue – for example, from the hand into the upper arm. In small, low-lying ganglia, there may also be only accompanying symptoms without any visible swelling.
Ganglion of the hand and fingers
A ganglion is particularly common on the hands or fingers. On the hand, it can occur on the back of the wrist or on the flexor side of the wrist. On the fingers, the proximal phalanges, but also the middle and distal phalanges may be affected. If a joint cyst forms on the feet, it usually occurs on the dorsum of the foot. If it occurs on the knee, the hollow of the knee is particularly affected. In rare cases, a ganglion can also form on the shoulder or elbow. At the wrist, the ganglion may only be visible when you bend the joint. If you still cannot see any swelling despite joint pain, you should consult a doctor. It may then be a deeper-lying ganglion. In addition to joint pain, a reduced grip strength of the hand can also be an indication of a joint cyst.
Diagnosing a ganglion
A ganglion can often be diagnosed with just a physical examination. In addition, to rule out other conditions, such as a tumor, procedures such as an x-ray or ultrasound examination and magnetic resonance imaging may be used. These methods are also used when a ganglion is neither visible nor palpable.
Conservative treatment for a ganglion
Exactly how a ganglion is treated often depends on whether or not symptoms are present. If there are no or only minor symptoms, it is usually waited to see if the joint cyst recedes on its own. Decongestant ointments as well as resting the joint can promote the regression of the ganglion. If the ganglion causes pain or the mobility of the hand or foot is restricted, measures such as physiotherapy are initially considered. This can, for example, strengthen the stability of the wrist and improve mobility.In addition, the following therapeutic measures are still possible:
- Needle puncture: the ganglion is punctured and the contained fluid is removed.
- Treatment with cortisone: cortisone is administered to reduce the swelling that has occurred.
- Treatment with hyaluronidase: enzymes are injected into the ganglion and break down the main component of the fluid, hyaluronic acid. The fluid is then removed by the doctor.
Surgical treatment for a ganglion
If conservative measures are not sufficient, the ganglion must be surgically removed. Surgery is also particularly necessary if the joint cyst causes such severe pain that conservative treatment is not an option. To treat the ganglion surgically, one should consult an appropriate specialist, a (hand) surgeon. During the operation, the surgeon tries to remove the entire ganglion. Not only is the fluid-filled cyst removed, but the connection to the joint capsule or tendon sheath is also closed. In about ten percent of all cases, a ganglion reappears at a later time. After surgical removal, however, the risk of recurrence is lower than with conservative treatment.
