Ganglion Cyst

Ganglion cysts are mostly harmless and do not cause any symptoms apart from the visible lump on the skin. The lump is not movable but is generally soft. However, it may present with the following symptoms when the ganglion puts pressure on the nerves:

• Pain in the affected area, especially on moving the joint
• Muscle weakness in the affected area
• Numbness 
• Tingling

An occult ganglion cyst is one which does not cause an obvious bulge in the skin, but it is present underneath the skin nonetheless.

The exact cause of ganglion cysts is unknown, though the following are some of the possible causes of this condition:

• Repeated injury to the joint
• Overuse of a joint (occupational, for example)
• A trauma to the joint
• Tear in the joint that leaks fluid

Ganglion cysts are also associated with medical conditions like arthritis. These cysts can affect anyone of any age. However, women (especially in the age group of 20-50 years) are three times more likely to develop ganglion cysts.

Also, gymnasts, who use their joints more often get ganglion cysts more frequently.

Ganglion cysts are most commonly diagnosed through physical examination. However, physicians also ask the patient to get some radiological tests like:

• X-rays: An X-ray helps check for any abnormalities in the bone/joint. A ganglion cyst does not show up on an X-ray but the bone abnormality would. 
• Ultrasound: Ultrasound test may be done to check the inside of the cyst—if it is fluid or solid.
• MRI scan: Sometimes an MRI scan is done to rule out tumours and better visualise the affected area when the other imaging tests do not give satisfactory results. Also, an MRI scan helps look for occult ganglion cysts.

Your doctor may also use a needle to remove some fluid from the cyst for confirming the diagnosis.

Most commonly, ganglion cysts just shrink and disappear on their own. So, your physician may tell you to keep an eye on the cyst. He/she may initiate treatment if the cyst increases in size or becomes painful. A ganglion cyst is treated in one of the following ways:

• Splint: If the affected joint or area is hurting a lot, your doctor may ask you to wear a splint or brace on the area. The brace will reduce pressure on the joint by reducing movement. This would also help reduce the size of the ganglion cyst which usually increases with repeated injury/movement. (Read more: Repetitive strain injury)
• Exercises: Exercises for joints are suggested to improve the range of motion of the joint and to improve muscle strength when there is no pain in the joint. (Read more: 5 early morning joint mobility exercises everyone should do)
• Needle aspiration: Needle aspiration involves draining the fluid from the painful cyst. For this procedure, your doctor will numb the affected area and insert a needle into the ganglion cyst. However, studies show that more than 50% ganglion cysts relapse after this procedure. This is because needle aspiration does not remove the root of the ganglion. In a lot of cases, about 75% of the fluid is removed at the time of diagnosis and further treatment may not be needed. 
• Surgery: A surgery for a ganglion cyst is only done when the other treatment methods do not work and the affected area is painful. In this surgery, the root of the cyst is removed. Surgical excision significantly reduces the risk of recurrence of the cyst. The surgery can be done as an outpatient procedure: you won’t have to stay at the hospital. However, even after surgery, there is a 15% chance of recurrence of the ganglion cyst. Also, cysts that are located just below the palm on the wrist, are not removed through surgery since they have a risk of harm to the radial artery—one of the major arteries in the body.

Read more: Ganglionectomy risks