Providing Quality Orthopaedic Care
Filed under: Patient Information
A ganglion is an out-pouching of fluid enclosed by a capsule of tissue, arising from a structure in the body. It can arise from a joint or from a tendon. They usually occur in areas of inflammation either from stress on a structure or from degeneration (wearing out as occurs in arthritis of the joint or tearing of a tendon). They commonly occur around the wrist where there are many tendons that can become inflamed or can arise from an arthritic joint such as the base of the thumb. It may present as a lump which incurs insidiously (out of the blue) and is often diagnosed by an ultrasound which is ordered by the General Practitioner although can be seen on MRI scan.
The ganglions themselves often are asymptomatic (cause no symptoms). However, there is often pain associated with the area and the patient will think that the ganglion is the cause of the pain. More commonly however the cause of the pain is the condition that causes the ganglion to occur in the first place ie. the degeneration of the tendon or the arthritis in the joint. As such unless the diagnosis( or the causation of the ganglion) is identified, then just excising the ganglion may not fix the symptoms. In assessing a ganglion one needs to look for a cause of the ganglion.
Consequently whilst a ganglion may seem straight forward ( which the patient just wants the thing removed), when a patient presents with a ganglion, at Glenelg Orthopaedics we believe that it is appropriate to further investigate the cause.
Often an x-ray and blood tests are required as well as a ultrasound. Despite all of these tests, often a cause cannot be identified.
Can the ganglion on its own cause symptoms?
Yes. A ganglion can cause symptoms in that if there is a large ganglion it can press on other structures and can also be unsightly and thus be a cosmetic problem. As such it is appropriate to treat some ganglions even if the cause for the ganglion cannot be identified.
Treatment options include injection of the ganglion and aspiration (sucking out the fluid that is in the ganglion, followed by an injection of cortisone to settle down the area of inflammation) or surgical options such as operation to excise the ganglion itself. Aspiration has a 50% success rate but in 50% of the cases the condition recurs. It is done under ultrasound guidance (by one of the radiology groups) has low risks and can always be repeated.
Surgery can be very successful in excising a ganglion and excising the tissue from where it has arisen from, however there is a recurrence rate and in the United Kingdom a large study has reported a low satisfaction rate and this may be because of recurrences which can still occur ( because the initial condition has not been treated) as well as the associated scarring and the risk of cutaneous nerve injuries around the ganglion meaning that small nerves around the skin can be bruised at the time of surgery.
Question- “My grandfather stated that hitting the ganglion with a bible would make the condition go away?”
To some extent your grandfather is correct in that often the ganglion can be burst in which case the ganglion sac leaks to the soft tissue surrounding it preventing a new ganglion forming. We would not recommend such traumatic technique of treating a ganglion but certainly rupture of the ganglion can be successful. This is usually best done however using an ultrasound guidance for aspiration or surgically.
No, it will not as long as it is not bothering the patient, it can certainly safely be left and often that is our advice.
A Baker’s cyst is a collection of fluid that develops from the knee joint and is often associated either with torn cartilage in the knee (meniscus) or arthritis in the knee, both conditions which produce fluid. When the fluid presents at the front of the knee it is known as swelling. If it however presents at the back of the knee it is known as a Baker’s cyst.
Excising the Baker’s cyst does not fix the underlying problem and in the knee scenario the Baker’s cyst is quite superficial and as such can continue to leak out through the skin if excised. Also the Baker’s cyst is close to the major neurological structures near the knee and as such, purely excising a Baker’s cyst does not produce any benefit and can have some significant side effects.
As such a Baker’s cyst is commonly associated with degeneration of the knee, and the treatment is to treat the degeneration either by an arthroscopic debridement of the torn cartilage or in the case of an arthritic knee, if the symptoms warrant it, a total knee replacement.
As such at Glenelg Orthopaedics we provide a balanced approach to assessment of an orthopaedic condition with the aim of providing quality orthopaedic care, treating the patient as we would expect to be treated. If you would like an assessment or second opinion, contact us on 8376 9988