Ganglion Cyst – In Wrist, Finger, Foot Treatment and Removal Surgery

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What is a Ganglion Cyst?

Ganglion cyst or a bible cyst is a rounded lump, which is generally present on a muscle tendon near a joint. It is typically noticed as a slow growing or static swelling, which is painless and does not cause any functional restriction. Historically, ganglion cysts were treated by hitting them with a bible, and hence the name, “bible cyst“. Except the unsightly appearance, ganglion cysts are completely harmless and have absolutely no propensity of becoming cancerous.

A neurofibroma is a similar lump occurring on nerves and has been known for cancerous transformation. Hence, it is very important to know whether one has a ganglion cyst or a neurofibroma.

Ganglion Cyst Causes and Symptoms

Ganglion cysts are filled with fluid which is quite similar to the synovial fluid of a joint. Though an absolute causal relation has not been established, yet many ganglion cysts are thought to arise from the joint capsule. Friction between a joint and the overlying tendons may have a major role in causing ganglion cysts.

Ganglion Cyst in Wrist

Ganglion cysts on wrist joint are exceedingly common. Ganglion cyst in wrist are located on the back of the wrist above the wrist bones scaphoid and lunate and are called dorsal ganglion cysts.

Ganglion cysts on the front of wrist are called volar ganglion cysts. The size of a ganglion cyst in wrist may vary from a pea to a small lemon, but sometimes it can be large enough to cover the entire wrist. Larger ganglion cysts, though quite rare, tend to restrict wrist motion to some extent. Many people with concurrent carpal tunnel syndrome or other ailments tend to wrongly attribute the ganglion cyst in wrist as a cause of their pain. But, it is a misconception, as ganglion cysts are never painful.

Ganglion Cyst Finger

Similar to wrist, a ganglion cyst in finger is present near the first or second inter-phalengeal joint on the outer aspect. Even a small ganglion cyst in finger or a ganglion cyst in thumb can lead to a faulty grip or inability to fluently use the hand. Longstanding ganglion cyst in finger can cause a permanent finger deformity. Hence, such ganglion cysts should be promptly removed.

Ganglion Cyst Foot

The most common site for a ganglion cyst in foot is just below and in front of the ankle. Ganglion cysts in toe can be particularly problematic for wearing shoes or sandals with a pointed tip. This is the place where several small ankle bones, joints, and tendons, are present, making it a highly dynamic area of the foot. They frequently remain unnoticed or are discovered incidentally during foot examination for some other reason. Sometimes an increase in the size of a ganglion cyst in foot makes wearing of shoes difficult or even painful.

Ganglion Cysts in Knee

It was earlier thought that, “Baker’s cyst” presenting on the back of knee, is a type of ganglion cyst in knee. Also a number of similar affections of the knee arise due to inflammation and infection of bursa’s around the knee. However, these are distinctly different than a ganglion cyst and should not be confused with it.

Pictures of Ganglion Cyst

Picture 1: Volar Ganglion Cyst on Wrist

(Source: Wikimedia Commons)

Picture 2: Dorsal Ganglion Cyst on Wrist

(Source: Wikimedia Commons)

Picture 3: Ganglion Cysts in Wrist and Finger

(Source: Pole Star Miami)

Ganglion Cyst Treatment

Firstly, there is nothing like ganglion cyst home treatment, because it requires surgical treatment, and that too after a through evaluation by an orthopedic or general surgeon. During initial visit to a surgeon, investigations, like Ultrasound (USG), X-ray, and routine blood counts, would be done to confirm the diagnosis, and is an important step in treating a ganglion cyst. If it is not causing any specific symptoms, like pain or restricted movement, a ganglion cyst should be left alone. Conservative methods like aspiration of ganglion cyst or needling followed by hyaluronidase therapy may be tried. This is especially important for volar ganglion of wrist, which is many times almost embedded to important wrist blood vessels. Removal of ganglion cyst in this area can cause an injury to blood vessels and compromise the bloody supply of the entire hand !

Ganglion Cyst Excision (Removal) Surgery

Normally, a ganglion cyst excision surgery is a simple procedure, as the ganglion cyst is generally not too deep. But the close proximity of blood vessels and tendons always leaves the possibility of complications and potentially grave outcomes. Hence, surgery for ganglion cyst excision should be performed by an experienced surgeon of the area in which the ganglion cyst is present. Removal of ganglion cyst in its entirety should be ensured, as breaking of the ganglion cyst during removal causes some of its parts to remain inside the body, and are prone to recurrence.

Arthroscopic ganglion cyst excision is the latest trend in treatment of ganglion cyst. It involves passing an optic fiber through a small incision, which helps proper visualization of the cyst and careful removal through a smaller second incision. This not only ensures complete removal of the intact ganglion cyst, but also helps in early healing of the surgical wound and preventing recurrence.

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