• www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at
  • www.sportordination.at

Ganglion in the hand

Definition:

 

A ganglion (also called a synovial cyst) is a benign soft tissue tumour in the hand that is usually very visible and palpable under the skin. It consists of a blister filled with a rubbery, clear fluid and comes out of the joint capsule in the wrist, or from one of the numerous tendon sheaths that circumvent the wrist. In 60-70% of cases, ganglions occur on the extensor side of the wrist, and more rarely on the flexion side (here often in close correlation with the radial artery) or at the proximal, middle or terminal phalanxes of the finger.

Women are three times more commonly affected than men and the peak age is between 20 and 30 years old.

The precise disease mechanisms that lead to the occurrence of a ganglion have not been clearly explained to date, however the following factors seem to play a key role:

  • A weakness in the capsular system (this can either be congenital or occur as a result of an injury, e.g. a fall onto the hand),
  • frequent overexertion and
  • chronic irritations in the wrist.

Symptoms:

 

The symptoms of a ganglion can range from complete freedom from symptoms to tenderness to severe pain (radiating into the elbow and fingers in certain circumstances). If the ganglion presses on nerves, numbness or pins and needles can occur in the fingers. Depending on the size of the ganglion, the patient can experience restrictions in movement. The spread is often dependent on exertion - the ganglion can become larger with more intense strain.

Image: A ganglion of this size can be very uncomfortable - and should therefore be removed

Diagnosis:

 

The diagnosis can often be clearly made on the basis of the clinical examination and the symptoms described. A firm elastic tumour in the area surrounding the wrist or a tendon sheath can be palpated. Small microganglions can be located using an ultrasound or MRI examination. To rule out arthrosis in some cases, an X-ray image of the wrist is taken.

Treatment:

 

50% of all ganglions disappear for a period of time, or even permanently, even without any treatment. As ganglions do not lead to damage to the tendons or nerves, only ganglions that cause symptoms or pain (e.g. a restriction of movement) should be treated.

Previously, the treatment involved trying to burst the ganglion using pressure. This is where the name "Bible cyst" came from, as in the past, the thick family bible was slammed on the ganglion, whereupon this often burst. However, as ganglions very frequently recurred, and the method is really painful, this treatment is hardly ever used today.

Some doctors promote what is known as "needling". For this, the ganglion is punctured multiple times with a needle and subsequently infiltrated with anti-inflammatory medications (cortisone). This method also, however, only leads to definite disappearance of the ganglion in around 40% of cases.

Image 2: Once the skin incision is made, the ganglion is easily visible

If a ganglion causes severe symptoms or there are restrictions to movement, it should be surgically removed. The ganglion is dissected and removed as far as its connection with the joint capsule through a small skin incision, the joint capsule must be fenestrated against recurrence of the ganglion. After the operation, careful mobilisation of the wrist should be carried out as quickly as possible to prevent adhesions.

Image 3: The whole extent of the ganglion can only be determined once it has been removed

The operation unfortunately also does not lead to confirmed healing in all cases. Depending on the operation method, the recurrence rate lies at 5-10%.

 

 

Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.