Ganglions and Baker’s Cysts
What is a ganglion?
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.
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 it can also be seen on MRI scan.
How do ganglions cause problems?
Ganglions themselves often are asymptomatic. 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. As such, unless 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.
Causes can include:
- Inflammatory conditions such as rheumatoid arthritis
- Osteoarthritis or wearing out of the joints
- Tendonitis
Whilst a ganglion may seem straight forward, 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 an 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 as, if large enough, it can press on other structures and can also be unsightly, becoming a cosmetic problem. As such it is appropriate to treat some ganglions, even if the underlying cause for the ganglion cannot be identified.
What are the treatment options for ganglions?
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 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. In the United Kingdom, a large study has reported a low satisfaction rate and this may be due to recurrences because the initial condition has not been treated, as well as the associated scarring and the risk of cutaneous nerve (small nerves around the skin) injuries around the ganglion.
“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, resulting in the ganglion sac leaking into the soft tissue surrounding it and preventing a new ganglion forming. We would not recommend such a traumatic technique of treating a ganglion but certainly rupture of the ganglion can be successful. This is usually best done using ultrasound guidance for aspiration or surgically.
Will a ganglion cause problems if left?
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.
What is a Baker’s Cyst? Is this another type of ganglion?
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. When the fluid presents at the front of the knee it is known as swelling. If it presents at the back of the knee it is known as a Baker’s cyst.
A Baker’s cyst is a mostly superficial issue. Excising the Baker’s cyst does not fix the underlying problem, and may result in continued leakage through the skin. The Baker’s cyst is also close to the major neurological structures near the knee. Purely excising a Baker’s cyst does not produce any benefit and can have some significant side effects.
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.
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.