Ganglion cyst

Ganglion cysts are benign subcutaneous tissue tumors (growths) in the hand in direct contact with the tendon sheath or joint capsule.

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Sinonimi: Bible cyst, Bible bump, Hygroma

How does it develop?

The exact cause is unknown.

It is considered that hand trauma can be a cause, or that disturbed flow of liquids through the tendon sheaths and joints with the combination of increased pressure in the area contributes to development of ganglion cysts.

Symptoms and signs

We make them out as lumps of to a couple of cm in size that are usually located in the back side of the wrist. Apart from this location, they can be found in the sides and the backs of fingers.

They can reduce the function of the hand, they rarely hurt, and the patients usually complain about the compromised esthetic appearance.

How is it diagnosed?

Diagnosis is made by a clinical examination and patient history (interview).

Biopsy can be done, although rarely, if the diagnosis is unclear, and a hand X-ray can be done in order to see the condition of the wrist joint.

How is it treated?

Ganglion cysts can spontaneously resolve in about 50% of cases, so surgical treatment shouldn’t be rushed.

Immobilization of the wrist can be attempted, beacuse it can help in a certain number of patients.

Yet, if it creates functional issues and pain, they can be easily treated by :

Injection aspiration
Surgical excision
3. Endoscopy

Learn more

Sinonimi: Bible cyst, Bible bump, Hygroma

Ganglion cysts are benign subcutaneous tissue tumors in the hand in direct contact with tendon sheaths or joint capsules.

We notice them as lumps or swellings whose size varies from a few mm to a few cm. They are hard, elastic, formations. They are commonly found in the back side of the hand (the dorsum), in the wrist area and in the back and sides of the fingers.

Diferrential diagnosis

Other soft tissue tumors of the hand.

Reasons for developing

The reason for developing them is unknown. In fact, there are two theories: First one considers the effect of trauma of the hand, and the second one ties the development to a disruption in the flow of liquids in the tendon and joint sheaths and an increase in pressure inside those sheaths, which together cause the formation of a sac in which the liquid content is collected .

Symptoms and signs

Ganglion cysts in the back of the hand

Size: averagely 2 cm
Pain varies from patient to patient, but rarely presents a major issue. Of course, in cases of extensive labor, pain becomes a significant problem.
Motion and function of the hand: depending on the size and every day usage, the functionality of the hand can be limited (especially with artists)
Esthetic appearance: This is the most common reason patients report this to us.

Comment

The term ‘hygroma’ was commonly used to describe the ganglion cyst in the back of the hand in the wrist area.

Ganglion cysts in other localizations in the hand

Most common areas are: in the wrist area, towards the thumb on the palmar side, and on the backs and sides of the fingers
Usually they are much smaller (averagely 5 to 10mm), and the symptoms are much less pronounced.

Complications

Reduction in functionality and the pain that compromises the quality of life and comfort, and reappearance, whether spontaneous or after a surgical treatment.

How is it diagnosed?

In most cases, a detailed clinical examination with history is enough. Diagnostic biopsy is recommended only in cases of unclear diagnosis, to differ from rare but possible malignant changes in the soft tissues of the hand. In rare cases, an X-ray is needed to assess the condition of the wrist joint.

Treatment

Large number of ganglion cysts spontaneously resolves (about 50%) and because of that surgical removal should not be rushed. Depending on the pain, functional issues, and eventual increase of the cyst, we recommend the following treatments:

Non-invasive minimal surgical treatments

Immobilization of the wrist
In a certain number of cases, when the ganglion cyst appears for the first time, this treatment can be successful by itself. Of course, immobilization should be applied after every other treatment.
Injection aspiration
Injection aspiration of the ganglion cyst content can be the most successful treatment in a large number of cases. This treatment is always combined with injection of steroids through the same needle after aspiration, for their anti-inflammatory effects. The success rate of this treatment is between 75% after only one aspiration, up to 85% after a few aspirations.

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Comment

Success is assessed on has the cyst returned after the treatment. In comparison of aspiration to surgical treatment, the first one is more successful, i.e. after an aspiration treatment the reappearance of ganglion cysts is less frequent.

Invasive surgical treatment

In all cases when aspiration treatment is not effective, and there are pronounced issues like pain and loss of function, advice is:

Radical surgical excision
This procedure entails an incision of the skin, with a separation of the ganglion cyst from the surrounding tissue and a complete removal.
Endoscopic (arthroscopic) removal
In contrast to classical surgical removal, the ganglion cyst is accessed through a minimal incision, and with the help of a camera, it’s completely separated from the surrounding tissue and then removed.

Comment

In all cases when a ganglion cyst should be removed, we give an advantage to the aspiration procedure. If this procedure doesn’t produce a result, and the ganglion cyst continues to grow, and pains and presents functional issues for the patient, we give the advantage to the classical surgical approach over the endoscopic one.

Risk factors and prevention

There are no specific risk factors, hence there is no specific primary prevention.

However, secondary prevention, whose basis is in early detection and timely treatment, can be of use to keep the problem from being pronounced. So, we advise the following:

If You notice a “swelling” of couple mm in size, hard to elastic, slightly painful to pressure, on the back of Your wrist or on the sides of Your fingers, You can try the following

Self help: immobilize Your wrist with an elastic band and reduce using the hand for a week at least or
2. Contact Your physician immediately after noticing the problem, or if Your self help hasn’t produced any results.