Comprehensive Ganglion Cyst Treatment at Nebraska Hand & Shoulder Institute, P.C.

Ganglion Cyst Causes and Symptoms

Ganglia develop from the connective tissue by liquefaction (decay) of collagen fibers, increasing the amount of fluid. Though many of the ganglia arise directly adjacent to a joint, they appear to be connected by a one-way valve mechanism allowing fluid from the joint to exit into the sac.

Ganglia may arise adjacent to a joint or tendon sheath and may be connected by a long stalk. Thus, their superficial appearance may not accurately represent the site of origin. Ganglia arising in response to degenerative arthritis of the interphalangeal joint are called mucous cysts and frequently result in deformity of the fingernail. If they go untreated and rupture, they may become infected. Ganglia cysts commonly occur in association with arthritis related to production of inflammatory fluid.

Advanced degenerative arthritis at the end joint of the finger (DIP joint) frequently results in a cyst known as a mucous cyst and may cause significant nail deformity.

Cyst caused by arthritis

Cyst at nail fold that has popped

Pressure from a cyst just above the nail fold has caused a deep trough in the nail. Removal of the cyst will allow the nail to grow back normally in about 4 months.

Ganglion Cyst Diagnosis and Treatment Options

Due to its classic location, size, and symptoms, physical examination is usually sufficient to diagnose a ganglion cyst. However, X-rays may be necessary to identify an underlying cause, such as arthritis, and exclude other possibilities.

Non-Operative Treatment

Non-surgical treatment options for lumps include observation, home remedies, and cortisone injections, although these may have varied success rates and recurrence risks. A person who notices a lump but does not experience pain or limitation from it has several choices. They may simply observe the lump and do nothing, hoping it resolves on its own. Another more unpredictable method is attempting to pop the lump by striking it, with the hope that it scars down and does not recur. However, this approach is not reliable. 

Surgical removal, or excisional biopsy, is another option, especially if the lump is large enough to be considered unsightly or is causing discomfort. An attempt to withdraw the jelly-like fluid from a ganglion cyst with a needle is largely unsuccessful; usually, the cyst will recur. While some physicians have reported good results from cortisone injection, in my experience, there is a high rate of recurrence post-injection. There is no strong physiological reason to believe that corticosteroids would be effective in resolving this issue.

Example of a mucous cyst

Nail deformity from a mucous cyst

Traditional Surgery (Wrist Ganglion):

Ganglion removal is best done using a small 1/2" transverse incision. The ganglion is exposed down to the joint and cut out along with a small wedge of the joint capsule.

Arthroscopic Surgery:

There is an arthroscopic technique for removing a wrist ganglion. It is straightforward and requires two small puncture wounds in the wrist. It is equally effective as open ganglion removal, but it leaves an even smaller incisional scar, and it costs a lot more due to the use of elaborate equipment.

For the person determined to absolutely minimize the size of the scar and for whom "money is no object" - there aren't many of those around - arthroscopic removal of a ganglion is a safe, straightforward outpatient procedure.

Surgical removal of ganglia, in general, is quite effective. However, in order to obtain a good result one must do the surgery in an operating room. This prevents injury to associated structures, such as the superficial nerves and arteries, and minimizes incision size. It decreases the chance of recurrence by allowing careful dissection down to the base of the ganglion and excision of the entire ganglion with its origin.

Post-Surgical Care and Rehabilitation

At Nebraska Hand & Shoulder Institute, P.C., we typically see minimal post-operative discomfort and a rare need for continued hand therapy. With an unrestricted movement approach, we encourage patients to get moving immediately to avoid stiffness. Our comprehensive ganglion cyst removal procedure offers an 85-90% chance of permanent cure. 

Let us help you eliminate the worry of an undiagnosed condition and provide you with comprehensive, expert care. Contact us today to schedule your ganglion cyst evaluation.