Home Diseases Ganglion (“overleg”): Causes & Therapy

Ganglion (“overleg”): Causes & Therapy

by Josephine Andrews
Published: Last Updated on 286 views

ganglion is also called, somewhat misleadingly, a ganglion – but it is not an ossification, but a fluid-filled bulging of a joint or tendon sheath. It usually forms on the hand, more rarely on the knee, foot or spine. Most of the time there are no complaints. Read more about causes and treatment here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

M67

quick overview

  • Treatment: If necessary, only observation and physiotherapy , otherwise surgery or aspiration; under no circumstances self-treatment by “smashing”
  • Symptoms: Elastic bulge from a few millimeters to a few centimeters in diameter, possibly pressure pain, restricted movement or numbness, but often without symptoms
  • Causes and risk factors: Not exactly known; Connective tissue weakness and risk factors such as joint diseases or increased joint loads probably play a role
  • Diagnosis: patient interview, physical examination, possibly imaging and fine-needle aspiration
  • Prognosis: Usually a favorable course, but ganglia often recur
  • Prevention: Avoid overloading joints, relaxation exercises

What is a ganglion?

Ganglion is the medical term for a ganglion. This designation is a relic from a time when it was thought to be a bony structure. In fact, a ganglion is a cystic sac, i.e. a fluid-filled cavity that usually occurs in joints (arthrogenically).

Ganglia are connected to the joint by a kind of socket, which is why they can hardly be moved. Doctors therefore now speak more precisely of a “synovial cyst”. (Synovia is the name for the synovial fluid.)

Where can a ganglion form?

Ganglia occur most frequently on the hand (in around 65 percent of cases): The ganglion develops here particularly on the back of the hand. Sometimes fingers or wrists are also affected. Less commonly, a ganglion develops at the hips, knees, feet, or spine .

This is what a ganglion looks like
A ganglion cyst forms as a fluid-filled sac around a joint or tendon sheath

Rarely, a ganglion occurs on the tendon sheaths (tendinogenic). In this case one also speaks of a tendon sheath ganglion. Another special form of the ganglion is the so-called intraosseous ganglion, which forms in a bone. So it curves inwards instead of outwards.

In principle, a ganglion occurs in people of all ages, including children. However, it is most common between the ages of 20 and 30. Women are affected more often than men. The reasons for this are naturally weaker connective tissue and more flexible joint capsules.

How is a ganglion treated?

If a ganglion causes no symptoms, it does not necessarily need to be treated. Some ganglia disappear on their own after a while.

However, many of those affected perceive a ganglion as cosmetically disturbing or it causes them discomfort (e.g. pain with certain movements, limited mobility). Then treatment is advisable. There are basically three ways to treat a ganglion: conservative treatment, aspiration, and surgery.

Which method is used in each individual case depends on several factors, such as the location of the ganglion. The patient’s wishes are taken into account when planning the ganglion therapy.

Can you treat a ganglion yourself?

The so-called bible or hammer therapy is not recommended! This brutal (self-therapy) method was often used in the past for ganglia. You try to smash the bone with a Bible or a hammer. Hence the name “Bible cyst” for ganglia. In the worst case, bones break. The method is historical and based on religious rather than medical knowledge.

Various home remedies to make a ganglion cyst disappear can be found in various sources such as treatment with pork fat and a cabbage leaf. The effect of this has not been medically described – under certain circumstances the effect is based on the quite healing immobilization of the joint, which is also used as a conservative treatment measure.

Bandaging and massaging the ganglion probably have a similar effect that cannot be proven with certainty – however, massage by a physiotherapist also often causes the ganglion ganglion to shrink or disappear.

There are also reports that ganglia have disappeared after several weeks of “treatment” with homeopathic globules or Schuessler salts. There is no scientific or conventional medical evidence for the effectiveness of these alternative healing methods, nor for “discussing” the ganglion or other measures.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Conservative treatment

A ganglion that does not affect the affected person is usually simply observed by the doctor at first. The ganglion may regress spontaneously or on its own with the help of physical therapy. Immobilization can prevent it from growing.

It is also important to avoid incorrect loading of the affected joint. After around three months of conservative treatment, the doctor discusses with the patient in most cases how the therapy should be continued.

aspiration

An aspiration, such as the doctor may have already used to make a diagnosis, can also be used therapeutically. In this form of ganglion treatment, the doctor pricks the ganglion with a fine hollow needle and sucks out the fluid it contains (needle puncture). In most cases, however, new fluid accumulates within a short time (ganglion recurrence).

That is why the doctor sometimes injects corticosteroids (cortisone) into the “emptied” ganglion after the aspiration. This is to prevent re-swelling.

Another option is to inject the enzyme hyaluronidase into the ganglion. It breaks down the main component of the liquid contained ( hyaluronic acid ). The doctor then sucks out the liquid using aspiration.

surgery

The surgical removal of a ganglion is considered to be very promising if it is carried out by an experienced specialist. The surgeon removes the ganglion and tries to close the joint so that no more fluid escapes. In principle, ganglion surgery can be open (through a larger skin incision) or minimally invasive (arthroscopic). As a rule, only a local or regional anesthetic is required for the ganglion surgery.

In some cases, such as a ganglionic finger, ganglionic wrist, or ganglionic foot or dorsal ganglion, a tourniquet may be applied during the procedure. It reduces blood flow to the affected area, reducing the risk of major bleeding. During the procedure, care must be taken to ensure that the ganglion is completely removed (without leaving any residue) and that important surrounding structures such as vessels, nerves or tendons remain undamaged.

After the operation, the operated area should initially be protected and immobilized. The patient may wear a splint for some time. Accompanying physical therapy often helps to prevent the joint from stiffening.

Complications of ganglion surgery

Complications occur in every tenth open operation. Arthroscopic interventions and aspiration procedures, on the other hand, cause significantly fewer problems at four and two percent, respectively. In particular, vascular (bleeding) and nerve injuries ( deafness , paralysis) are more common in open surgery. There is also a risk of infections, wound healing disorders and the development of Sudeck’s disease (a chronic pain syndrome). In addition, as after any operation, a (small) scar remains.

What to do if the ganglion bursts

It is possible for an untreated ganglion to rupture unintentionally. In the past, brute force methods such as “hammer or bible therapy” were even deliberately attempted – which doctors strongly advise against because of the risk of injury.

A ruptured ganglion heals on its own in many cases. However, there is a risk that the wound will become infected or that the ganglion will appear again. It is best to see your doctor with a sprained ligament to avoid complications.

symptoms

Those affected usually notice a bump on the wrist or back of the hand, more rarely on other parts of the body. It is possible that several ganglions develop.

The “knob” on the wrist or other parts of the body is typically elastic . On average, it has a diameter of a few millimeters to two centimeters . But there are also ganglia that grow up to eight centimeters in size. Some remain so small that the affected person does not even notice the protuberance and it is only discovered by chance.

Typically, a ganglion causes no pain and is otherwise hardly noticeable. Depending on its size and location, however, it restricts the mobility of joints and muscles or is painful when the affected person leans on it. The (pressure) pain may radiate. The ganglion may also hurt when moved or touched.

If a ganglion presses on tendons, it is possible that it will squeeze them and possibly cause inflammation (tendonitis) due to the permanent strain.

Numbness, tingling , or weakness in the hand is a possible indication that the ganglion is “pinching” a nerve. The nerves in the so-called annular ligament ganglia are often affected. These are small protuberances on the ring bands of the fingers, which may make it difficult to bend and stretch.

But the wrist or foot (back) are also susceptible to pinched nerves and vessels. Pressure on vessels can cause bleeding. In addition, it is possible for infections to spread in the fluid-filled space of the ganglion.

Causes and risk factors

The exact causes of a ganglion are not yet known. It is likely that several factors play a role in the development of a ganglion. For example, a connective tissue weakness:

Around the joints there is (solid) connective tissue, the so-called joint capsule. This holds the joint in position and ensures that it only moves in the desired direction. In the joint, a soft layer of connective tissue (synovial membrane) lines the joint cavity like wallpaper. The joint cavity contains bile-like fluid (“joint grease”), without which the bony parts of the joints would rub against each other.

In the case of connective tissue weakness, in some cases in connection with overloading of the joint, synovial fluid leaks out of the joint cavity and collects in the surrounding soft tissue. This is how a ganglion develops, experts suspect.

risk factors

Risk factors for a ganglion cyst include:

  • Increased stress on joints such as repeated minor injuries to the capsule and ligaments
  • Disorders in the biomechanics of the joint or tendon
  • Joint diseases and rheumatic diseases (such as arthrosis, lupus erythematosus , gout )

About ten percent of patients have previously injured themselves in the area of ​​the ganglion. In addition, in the case of a ganglion, the connective tissue cells (fibroblasts) probably stimulate the production of synovial fluid. Its components, hyaluronic acid and so-called mucopolysaccharides, form a viscous liquid that then collects in the ganglion.

In addition, damage to the tissue caused by wear and tear probably plays a role in the development of a ganglion.

investigations and diagnosis

See an orthopedist or surgeon if you suspect a ganglion cyst. He excludes any underlying diseases such as arthrosis as a trigger for the lump. It is best to contact a doctor who specializes in the affected body region, for example a hand surgeon for a ganglion on the hand.

To clarify the suspected ganglion, the doctor usually proceeds as follows:

Collection of the medical history: In a conversation with the patient, the doctor asks about the exact symptoms and any injuries and underlying or previous illnesses. Possible questions from the doctor in this anamnesis interview are, for example:

  • When did you first notice the swelling?
  • Does the swelling affect the mobility of the affected part of the body or does it cause pain?
  • Have you ever injured yourself in the affected area?
  • Have you ever had similar “lumps” before?
  • Are there similar swellings elsewhere?

Physical exam: After this, the doctor examines the swelling to evaluate it more accurately. A ganglion feels elastic to the touch, similar to a solid rubber ball. Due to its anchorage to the joint or the tendon sheath, it can only be moved slightly. In contrast to highly inflammatory processes, the affected region is neither overheated nor reddened. The doctor may take photos for documentation.

He will also check blood circulation, motor skills and sensitivity in the affected body region. For example, it recognizes movement restrictions caused by the ganglion, circulatory disorders and nerve damage. “Transillumination” of the swelling is also possible: by shining a light source through the side of the ganglion, the doctor can determine whether the inside is liquid (indication of a ganglion, cyst) or solid.

Imaging: Imaging procedures are uncommon in ganglia. They are only used when the case is unclear and, for example, a malignant process or arthritis is suspected. Even if the doctor suspects a “hidden” ganglion, it is possible to confirm or refute this suspicion using ultrasound and magnetic resonance imaging (magnetic resonance imaging, MRI).

Fine- needle aspiration: For diagnostic and therapeutic purposes, the doctor pricks the ganglion with a very thin, hollow needle under ultrasound control in order to draw fluid from the inside. A pathologist then examines this mostly viscous, clear liquid in the laboratory. In this way, inflammation or malignant processes can be ruled out. Draining fluid from the ganglion causes it to visibly shrink. In most cases, however, this is not a permanent solution.

Course of the disease and prognosis

A ganglion is a benign protuberance with a favorable course. It often regresses spontaneously, but also enlarges in some cases. Most of the time it doesn’t cause any symptoms. Depending on the location, however, it causes (pressure) pain or numbness or restricts the mobility of the affected joint.

If a ganglion has been successfully treated, there is a risk of recurrence (recurrence): it is possible for a new ganglion to form in the same or a different place. Surgery on a ganglion seems to be the most lasting: only about every fifth patient develops another cystic protuberance in the same place after open surgery. With minimally invasive surgery, the risk of recurrence is even lower.

After an aspiration treatment, on the other hand, a ganglion bone develops again in half of the patients.

Prevent

In order to prevent relapses, risk factors for ganglia should be reduced and the muscles should be relaxed and relaxed again and again. This prevents overloading, which may promote a ganglion.

In general, however, it is difficult to prevent a ganglion.

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