Robert J. Snyder, MD
Ganglion Cysts or “wens” as they are colloquially referred to, are small sacs attached to a joint or a tendon with a stalk. This stalk is the conduit for the jelly-like fluid (similar to the synovial fluid found in joints) which fills the cyst. These cysts are usually found near a joint or tendon and are most commonly seen on the fingers on the joints nearest the fingernails. Your grandma may have taken an encyclopedia and whacked your grandpa’s wen as a method of treatment. Today, we prefer other ways of treating ganglion cysts.
Some ganglion cysts, while they may be unsightly, never hurt at all and don’t cause any problems. After a while, they may go away on their own. However, some do cause problems. This may be because of their location on the body and when too close to a joint, may make movement difficult. When full of fluid, they may press on a nerve, causing pain, weakness, tingling or numbness. Women, between the ages of 20-40, are more prone to get them and they often happen in the joints nearest the fingernails, that have been injured or have osteoarthritis.
When a patient comes to me for treatment for a suspected ganglion cyst, I do a few diagnostic tests to make sure we are dealing with a cyst and not a tumor or some other type of growth. I often will shine a flashlight on the cyst to make sure the contents are translucent and not a solid mass. I may get an x-ray of the cyst to rule out boney growth or a tumor. I also can aspirate the contents of the cyst to make sure the contents are thick and clear and not infected, bloody, or cloudy, indicating another issue.
Our first line of treatment is to go one of two ways: 1) immobilize the joint/tendon nearest the cyst to see if we can get the fluid in the cyst to dissipate (activity tends to cause more fluid to accumulate); or 2) aspirate the fluid out of the cyst with a needle. Some patients will do anything to avoid a needle, but others want to move directly to the option that will bring the quickest results. Whatever option we choose, the patient will have to follow up with me to let me know if the treatment worked, or if we need to try something else.
Sometimes, I recommend surgical removal for cysts that keep refilling and causing pain or loss of function. These surgeries are outpatient and are typically done under a local or twilight sedation with minimal recovery time. Removal of the cyst tends to be simple, but the removal of the stalk can be complex and involves extraction from the joint or tendon. Occasionally, there are cysts/stalks that can’t be removed surgically due to their proximity to a vital nerve and the risk of damage to that nerve. These have to be managed with either immobilization or repeated aspiration of the cyst or both.
Ganglion cysts are a wonder of nature. You can treat them and even remove them surgically, but you can never guarantee they will be gone permanently. No one knows why, but they have a habit of recurring in the same spot.