Table of Contents
WHAT IS A GANGLION CYST?
A ganglion cyst is a benign fluid-filled sack typically found in the fingers, wrist and toes, but can appear over almost all joints of the body. This sack is typically filled with synovial fluid, which is a gel-like fluid that is found in joint spaces.
WHAT CAUSES THE FORMATION OF GANGLIONS?
It is commonly thought that ganglion cysts arise from weakening of the joint capsule/tendon sheath of the joint often due to strain or trauma.
This hypothesis is based on the idea that these cysts are often found along joint spaces/tendinous sheaths and the fluid found in these cavities is synovial fluid.
I'VE BEEN TOLD THAT I CAN SMASH THE CYST WITH A LARGE BOOK, CAN I DO THAT?
Although these cysts are benign and do not require removal, they are often located in an area where there is frequent contact with other surfaces causing irritation and discomfort. In the past, people have used large books, such as the bible, to forcibly burst these cysts, giving ganglion cysts the nick name of "bible cysts". Although this is one method of dealing with the cyst, it is not recommended, as it can often cause injury to other areas. Additionally, other tumours grow in the areas where ganglion cysts arise and can mimic ganglion cyst. It is therefore advisable to have such lesions professionally removed by a plastic surgeon to rule out other pathologies.
WHAT ARE THE DIFFERENT METHODS OF TREATING A GANGLION CYST?
Typically, there are two ways to treat a cyst. If these sacs are managed early, the fluid in the sac isn't too thick and can be aspirated from the sac with a needle. However, sometimes, depending on location or the consistency of the fluid, you may need a surgical excision of the sac to ensure lower recurrence rates.
WHAT ARE MY NON-SURGICAL OPTIONS?
If you are not experiencing any problems or irritation from the cyst, you may choose to not receive any treatments. Small cysts sometimes resolve on their own.
Typical non-surgical management involves aspirating/expressing the fluid using a needle to open up the sac. (Please do not do this yourself at home. Using non-sterile needles can cause infections to nearby joints and may cause injury to other areas the hand.)
WHAT ARE THE CHANCES THAT THE CYST WILL COME BACK AFTER SURGERY?
The chances of re-occurrence ranges from 12 to 41%, but this depends on the patient's genetic predisposition, as well as the frequency of use of the joint affected.
WHY DO I NEED SURGERY IF THE CYST CAN BE REMOVED USING A SIMPLE NEEDLE?
Different factors help determine whether cysts should be removed surgically or simply aspirated with a needle. The size of the cyst and location of the cyst may make it easier/harder to aspirate. For example, if the cyst is large and very superficial, it is accessible for aspiration. Additionally, the thick consistency of the fluid in the cyst makes it hard to aspirate/express the fluid from the sac.
There are significantly higher rates of recurrence when the cyst is aspirated as opposed to surgical excision. During a needle aspiration, the lining of the cyst is not removed so synovial fluid can refill the sac eventually forming a new cyst. When the cyst is surgically excised, the lining of the sac is removed completely and any tears or injuries to the tendons are repaired to help prevent further development of cysts.
WHAT HAPPENS IF I DELAY OR CHOSE NOT TO HAVE SURGERY?
The outcome of delaying or foregoing treatment varies. Sometimes cyst may become larger, they may decrease in size and disappear and/or they remain the same over long periods of time.
HOW SOON WOULD YOU RECOMMEND THAT I HAVE SURGERY?
Removal of the cyst is not urgent and you can decide when it is convenient if you choose to have the cyst surgically removed.
When it is convenient, you should have your family doctor refer you to Dr. Chivers’ office at the Canadian Plastic Surgery Centre. Our contact information can be found under the Contact Us page.