Ganglion Cyst: Annoying, But Thankfully Non-Cancerous
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A ganglion cyst is a harmless, although annoying, non-cancerous growth that forms directly under the skin. Ganglia usually occur in clusters, on or near tendon sheaths and joint capsules. (These benign growths should not be confused with the cluster of nerve cells that is also referred to as a ganglion.) Formed of the same jellylike substances found in fibrous tissue, ganglia may feel either hard or soft to the touch. A typical ganglion is the size of a pea, but some grow as large as a walnut, especially if they become inflamed.
Most often, ganglia develop along the wrist, especially on the back of the hand. Less often, they form on the fingers, palm, or around the ankle. The underlying cause is unknown, but in some cases their occurrence seems to be associated with repetitive stress injuries, as from playing tennis or practicing certain musical instruments.
Ganglia occur most frequently in children, teenagers, and young adults. Unfortunately, they often recur even after removal. For example, about 10 percent of wrist ganglia grow back after surgical removal.
Diagnostic Studies and Procedures
A doctor can usually tell by visual and tactile inspection whether a lump or swelling is a ganglion or a group of ganglia. For further confirmation, an X-ray of the affected area and possibly a sonogram, or ultrasound scan, may be ordered. To ensure that the lump is non-cancerous, the physician may decide to submit a sample of the fluid for laboratory analysis. To obtain the sample, a doctor or nurse inserts a needle into the lump and withdraws a small amount of the fluid into the syringe. This procedure is called needle aspiration or needle biopsy.
Most small ganglia do not require treatment. If a ganglion becomes inflamed and painful, a doctor may inject it with cortisone. Alternatively, she may withdraw as much of the jellylike substance as possible and then inject the ganglion with cortisone in the hope of preventing its regrowth.
Another treatment, called sclerosing, involves injecting a solution that causes the ganglia to dry up and turn into scar tissue. This procedure must be done carefully, because it can damage the joint lining or nearby nerves, and result in a loss of function.
Surgical Treatment. If you have a ganglion that is unsightly or interferes with normal activities, you may want to consider surgical removal. The procedure, called a ganglionectomy, is considered minor surgery, which usually requires only a local anesthetic and can be done in the doctors office. For a wrist ganglion, however, a surgeon trained in hand operations should perform the ganglionectomy, since expertise is needed to avoid damaging the nerves that control the fingers. With all such procedures, a magnifying device should be used to ensure that tiny satellite ganglia are removed, reducing the chance that growths will recur.
Following the operation expect the hand to swell. You will probably wear a wrist splint for a week to allow healing. Stitches will then be removed, but you should use the wrist cautiously for yet another two weeks, taking care to avoid lifting or any sudden twisting movements that can interfere with healing. The operation will leave a small scar, and when the tissues are completely healed, a few sessions with a physical therapist may be required to restore the joints range of motion.
In some parts of the world, ganglia are known as "Bible bumps." This odd term came about because there were people who once believed that the best way to eliminate a ganglion was to whack it with the family Bible or any heavy book. Traditional though it may be, this method is dangerous. It can damage surrounding tissues and fracture the small bones of the wrist and hand.
Acupuncture. A few sessions with an acupuncturist may result in rupture of a ganglion. If this happens, the substance inside it will be reabsorbed by the body, although the growth may eventually recur.
Shiatsu or acupressure. These and other forms of massage therapy may have the same effect as acupuncture.
In many instances, ganglia rupture spontaneously and disappear. But do not attempt to rupture a ganglion by squeezing or pressing it; you may end up with painful inflammation.
If a ganglion does become inflamed, an over-the-counter anti-inflammatory medication such as aspirin or ibuprofen should provide relief from both the pain and swelling.
Other Causes of Hand Growths
The hand is especially vulnerable to benign growths that resemble ganglia. These include cysts, nerve tumors, warts, fibromas, and bony growths, spurs, and bosses (swellings).