Ganglion cyst

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A ganglion cyst is a fluid-filled lump associated with a joint or tendon sheath. They most commonly occur in the back of the wrist followed by the front of the wrist. Onset often occurs for months. There is usually no further symptoms. Sometimes pain or numbness can occur. Complications may include carpal tunnel syndrome.

The cause is unknown. The underlying mechanism is believed to involve outpouching of the synovial membrane. Risk factors include gymnastics. Diagnosis is usually based on an examination with a glowing light through a supportive lesion. Medical imaging can be done to rule out other potential causes.

Treatment options include waiting vigilantly, splitting affected joints, needle aspiration, or surgery. About half their time alone. About 3 per 10,000 new people develop a wrist or hand ganglion a year. They are most common in young and middle-aged women. Trying to treat a lesion by hitting it with a book is not recommended.

Video Ganglion cyst

Signs and symptoms

The average size of this cyst is 2.0 cm, but cysts removed over 5 cm have been reported. The size of the cyst may vary over time and may increase after activity.

Site

These cysts most commonly occur around the dorsum of the wrist and fingers. The common place of occurrence is along the extension of the carpi radialis brevis, as it passes through the dorsum of the wrist joint. Although most commonly found in the wrist, ganglion cysts may also occur in the legs.

Ganglion cysts "are often found in relation to the appendicular cavity joints and tendons, with 88% 'in communication with several small hand and wrist joints' and 11% with the feet and ankles." They are commonly found near the wrist joint, especially in the scapho-lunate area.

In a 2007 study of patients in Glasgow whose lumps were surgically removed, 39 of the 101 cases were ganglion cysts. This study replicates earlier findings that no ganglion cyst is found on the soles of the feet or heels; the authors wrote that "Although the lump in this area may be ganglia, the surgeon may have to consider another diagnosis in the first instance." The investigators also noted the dominant incidence among women (85%) and 11 from other cases had been misdiagnosed as ganglion cysts before surgery.

Ganglion cysts are not limited to hands and feet. They may occur near the knee, generally near the cruciate ligament, but also they can occur in the origin of the gastrocnemius tendon and, anteriorly, on the Hoffa infrapatellar fat pad. On the shoulders, they usually occur in acromioclavicular joints or along the biceps tendon.

From their common origins in joints or tendons, ganglion cysts can form in various locations. Intraosseous ganglion cysts are rare, sometimes in combination with cysts in the upper soft tissues. Very rare cases of intramuscular ganglion cysts in the gastrocnemius muscle in calves have been reported. It is possible for a cyst to be moved away from the connection to the joint. In one extreme case, ganglion cysts were observed to spread widely through the channels from the general peroneal nerve sheath to the site on the thigh; in such cases as surgery to the proximal joint to eliminate the articular connection may eliminate the need for more risky and wider operations on the thigh nerve tissue. Cysts can disrupt the spine, which can cause pain and disesthesia in distant extremities.

It has been suggested recently that adventitial cystic disease, in which cysts occur within the popliteal artery near the knee, may occur with an articular mechanism, with a channel leading from the joint, similar to the development of ganglion cyst, which spreads in the peroneal nerve.

Cysts that suppress one or more nerves and cause bone erosion have been reported to occur near the shoulder joint.

Maps Ganglion cyst

Cause

The most likely cause of the most commonly accepted ganglion cyst is the "herniation hypothesis," in which they are thought to occur as "out-of-pocket or disturbing the weakening portion of the joint capsule or the tendon sheath." This description is based on the observation that the cyst occurs close to the tendons and joints. The microscopic anatomy of the cyst resembles the tenosynovial tissue, a fluid similar in composition to the synovial fluid. Dyes injected into the joint capsule often end up inside the cyst, which may dilate after the move. The dye injected into the cyst rarely enters the joint, however, which has been associated with the apparent formation of an effective and one-way "valve", allowing the fluid to escape from the joint, but not returning.

In synovial, post-traumatic degeneration of connective tissue and inflammation has been considered a cause. Other possible mechanisms for the development of ganglion cysts include recurrent mechanical stress, facial arthrosis, perixicular fibrous myxoid tissue degeneration and liquefaction with chronic damage, increased production of hyaluronic acid by fibroblasts, and mesenchymal cell proliferation. Ganglion cysts may also develop independently of the joints.

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Diagnosis

Ganglion cysts are easily diagnosed, because they are visible and pliable to the touch.

Radiography in AP and lateral views should be obtained to exclude a more serious basic pathology. Ultrasonography (US) may be used to increase diagnostic confidence in clinically suspected lesions or to describe hidden cysts, because intratendinous ganglia are easily distinguished from extratendinous ganglia during dynamic ultrasonography, because microscopically, ganglionic cysts are thin-walled cysts containing clear fluid clear.

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Treatment

In addition to the frequent choice to leave the cyst in place, surgical treatment remains the ultimate elective choice for the treatment of ganglion cysts. The development of ganglion surgery around the world is using the method of arthroscopy or mini opening. Alternatively, hypodermic needles may be used to drain fluid from the cyst (via aspiration) and corticosteroids may be injected after the cyst is empty; However, if the fluid has thickened, due to the passage of time, this treatment is not always effective. There is a recurrence rate of about 50% after drainage of the needle (through aspiration) of the ganglion cyst.

One common and traditional method of treatment for ganglion cysts is to attack the lump with a ledger and weight, causing the cyst to rupture and flow into the surrounding tissue. Historically, the Bible is the largest or only book in any particular household, and is often used for this treatment. This led to the nickname "Bible Stains" or "Gideon's disease" for this cyst. This treatment risks hurting the patient.

Complications

Treatment complications may include joint stiffness and scar formation. Recurrence of lesions is more common after excision of volar ganglion cysts on the wrist. An incomplete excision failing to insert a stalk or pedicle may also cause a recurrence, as it will fail to carry out the closing of the layered incision.

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Prognosis

The recurrence rate is higher in the aspiratory cyst than the cyst being excised. Ganglion cysts are found to recur after surgery in 12% to 41% of patients.

A six-year study results from the treatment of ganglion cysts on the dorsum (back) of the wrist versus excision, aspiration, and no treatment. Exclusion or aspiration does not provide better long-term benefits than without treatment. Of untreated ganglion cysts, 58% recover spontaneously; the postoperative recurrence rate in this study was 39%. A similar study in 2003 of ganglion cysts that occurred on the palmar wrist surface stated: "In 2 and 5 years of follow-up, regardless of treatment, no differences in symptoms were found, regardless of whether palmar wrist ganglion was cut, sucked or left alone. "

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Etymology

Being mistaken that has survived into modern times, ganglion cysts are not associated with "ganglion" nerves or "ganglion cells"; his etymology traces back to ancient Greece ???????? , "knot" or "swelling under the skin", which extends to the nerve mass by analogy. Generally, Hippocrates is credited with the description of this cyst.

The term "biblical cyst" (or "biblical bump") comes from an urban legend that historical care consists of hitting a cyst with a Bible. However, trying to treat a lesion by hitting it with a book is not recommended.

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See also

• Ganglioneuroma

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References

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External links

• MRI shows a cyst on the knee
• American Academy of Orthopedic Surgeons - Gang Gang from wrist
• Canada Health and Safety Center - Ganglion Cysts

Source of the article : Wikipedia