Cause of ganglion cysts a mystery

Ganglion cysts are unsightly and sometimes painful. But while the fluid-filled sacs clustered around wrists and other joints are common, not a lot is known about their cause. A trip to the doctor can give sufferers some peace of mind that they are not a serious medical problem — or some options for having them removed, says Dr. Stacey H. Berner, medical director of the Hand and Upper Extremity Center at Northwest Hospital Center.

QUESTION: What are ganglion cysts?

ANSWER: Ganglion cysts are fluid-filled tissue sacs. They occur adjacent to joints and tendon sheaths. Although they can occur in association with nearly all of the joints in the body, they are most common in the wrist. In fact, they are the most common type of lump seen in the hand and wrist and are estimated to represent 50-70 percent of the masses that are encountered in these locations. Fortunately, they are benign or non-cancerous.

Q: Are they always on the hand?

A: The most common location is the dorsal (opposite the palm) surface of the wrist, and the second most frequent location is the palmar side of the wrist. They are raised bumps with generally well-defined borders. They vary in consistency from soft and compressible to firm.

Q: Who gets them and why?

A: They are rarely seen at birth, and therefore they are considered acquired, rather than congenital. They can be seen in children and adolescents as well as adults. In younger individuals, they may resolve spontaneously, however in mature individuals who have completed their skeletal growth, it is infrequent for ganglion cysts to resolve without treatment.

The diagnosis can usually be made through examination by an experienced health care practitioner, such as a hand surgeon. Occasionally, diagnostic studies such as an MRI scan or ultrasound may be useful if the diagnosis is not entirely clear. Despite the fact that the incidence of these lesions is quite high, their cause remains unknown. It has been suggested that individuals that develop these cysts may have some predisposition to forming them. No clear-cut link between a specific activity and the development of ganglion cysts has been established.

Q: Will they go away on their own?

A: It is not an absolute necessity to treat ganglion cysts. Simple observation and reassurance are appropriate in some cases. However, many individuals elect to have them treated. Among the common reasons that patients seek treatment are the appearance of these raised, noticeable lumps, and pain. Cysts may cause pain due to the pressure buildup of fluid within their walls. They can also cause discomfort by pressing on adjacent structures such as nerves, tendons and blood vessels.

Q: Do they need medical attention, or are there home remedies?

A: Historical treatments have included manual dispersion as well as striking the cysts with a heavy object, such as a book. These treatments are understandably uncomfortable and are associated with very high rates of recurrence. Aspiration, or drawing the fluid out with a hypodermic needle and syringe, has been associated with rates of recurrence from 50 percent to 90 percent.

Surgical treatment can be performed through an open surgical excision or by minimally invasive arthroscopic obliteration of the cyst. Rates of recurrence with open techniques have been quoted to range from 10-40 percent. Arthroscopic studies have demonstrated recurrence rates of 4 percent to 12 percent. Realistically, modern experience suggests rates of recurrence at 10 percent, or perhaps slightly higher with all techniques. Recurrence rates may be a bit higher for cysts on the palm side of the wrist.

The theoretical advantages of minimally invasive or arthroscopic obliteration of the cysts are rapid recovery, relatively low recurrence and improved cosmetic appearance. The drawbacks of the minimally invasive approach are the necessity for more elaborate operating-room equipment, and the indirect nature of the procedure, as it is visualized on a video screen.

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