A ganglion cyst is a fluid-filled bump associated with a

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...

tendon sheath A tendon sheath is a layer of synovial membrane around a tendon. It permits the tendon to stretch and not adhere to the surrounding fascia. It has two layers: * synovial sheath A synovial sheath is one of the two membranes of a tendon sheath wh ...

. It most often occurs at the back of the

wrist In human anatomy, the wrist is variously defined as (1) the Carpal bones, carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known ...

, followed by the front of the wrist. Onset is often over several months, typically with no further symptoms. Occasionally, pain or numbness may occur. Complications may include

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunn ...

. The cause is unknown. The underlying mechanism is believed to involve an outpouching of the

synovial membrane The synovial membrane (also known as the synovial stratum, synovium or stratum synoviale) is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath. It makes direct contact with the fibrous ...

. Risk factors include

gymnastics Gymnastics is a type of sport that includes physical exercises requiring balance, strength, flexibility, agility, coordination, dedication and endurance. The movements involved in gymnastics contribute to the development of the arms, legs, shou ...

activity. Diagnosis is typically based on examination with light shining through the lesion being supportive.

Medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to rev ...

may be done to rule out other potential causes. Treatment options include

watchful waiting Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed. Related terms include ''expec ...

, splinting the affected joint,

needle aspiration Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, aft ...

, or

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

. About half the time, they resolve on their own. About three per 10,000 people newly develop ganglion of the wrist or hand a year. They most commonly occur in young and middle-aged females.

Presentation

The average size of these cysts is 2.0 cm, but excised cysts of more than 5 cm have been reported. The size of the cyst may vary over time and may increase after activity. Between 50 and 70% of all masses on the hand and wrist are expected to be ganglion cysts.

Sites

Ganglion cysts most frequently occur around the dorsum of the wrist and on the

finger A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers ( Pentadactyly). Chambers ...

s. A common site of the occurrence is along the

extensor carpi radialis brevis In human anatomy, extensor carpi radialis brevis is a muscle in the forearm that acts to extend and abduct the wrist. It is shorter and thicker than its namesake extensor carpi radialis longus which can be found above the proximal end of the exten ...

, as it passes over the dorsum of the wrist joint. Although most commonly found in the wrist, ganglion cysts also may occur in the foot. Ganglion cysts are "commonly observed in association with the joints and tendons of the

appendicular skeleton The appendicular skeleton is the portion of the skeleton of vertebrates consisting of the bones that support the appendages. There are 126 bones. The appendicular skeleton includes the skeletal elements within the limbs, as well as supporting shou ...

, with 88% 'in communication with the multiple small joints of the hand and wrist' and 11% with those of the

foot The foot ( : feet) is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made ...

and

ankle The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular join ...

Wrist

They commonly are found near the wrist joint, especially at the scapholunate area. Common wrist ganglions include: * dorsal wrist ganglion * volar wrist ganglion * volar retinaculum ganglion * extensor retinaculum ganglion * occult ganglion * intraosseous ganglion * mucous cyst

Foot

In a 2007 study of patients in

Glasgow Glasgow ( ; sco, Glesca or ; gd, Glaschu ) is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated popul ...

whose foot lumps were removed surgically, 39 of 101 cases were ganglion cysts. The study replicated earlier findings that no ganglion cysts were found on the sole or heel. The authors wrote, "Although lumps in these areas may be ganglia, the surgeon should probably consider other diagnoses in the first instance." The researchers noted a preponderance of occurrence among females (85%) and that 11 of the other cases had been misdiagnosed as ganglion cysts before surgery. Ganglion cysts are not limited to the hands and feet. They may occur near the

knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...

, commonly near the

cruciate ligaments Cruciate ligaments (also cruciform ligaments) are pairs of ligaments arranged like a letter X. They occur in several joints of the body, such as the knee joint and the atlantoaxial joint, atlanto-axial joint. In a fashion similar to the cords i ...

, but they may occur at the origins of the

gastrocnemius The gastrocnemius muscle (plural ''gastrocnemii'') is a superficial two-headed muscle that is in the back part of the lower leg of humans. It runs from its two heads just above the knee to the heel, a three joint muscle (knee, ankle and subtalar ...

tendon, and anteriorly on Hoffa's infrapatellar fat pad. At the shoulder, they typically occur at the

acromioclavicular The acromioclavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. It is a plane synovial joint. Structure ...

joint or along the biceps tendon.

Other

From their common origin at a joint or tendon, ganglion cysts may form in a wide range of locations. Rarely,

intraosseous Intraosseous infusion (IO) is the process of injecting medications, fluids, or blood products directly into the marrow of a bone; this provides a non-collapsible entry point into the systemic venous system. The intraosseous infusion technique i ...

ganglion cysts occur, sometimes in combination with a cyst in the overlying soft tissue. Rare cases of intramuscular ganglion cysts in the

gastrocnemius muscle The gastrocnemius muscle (plural ''gastrocnemii'') is a superficial two-headed muscle that is in the back part of the lower leg of humans. It runs from its two heads just above the knee to the heel, a three joint muscle (knee, ankle and subtala ...

of the calf have been reported. It is possible for a cyst to be considerably displaced from the joint. In one extreme case, a ganglion cyst was observed to propagate extensively via the conduit of the

common peroneal nerve The common fibular nerve (also known as the common peroneal nerve, external popliteal nerve, or lateral popliteal nerve) is a nerve in the lower leg that provides sensation over the posterolateral part of the leg and the knee joint. It divides at ...

sheath to a location in the thigh; in such cases surgery to the proximal joint to remove the articular connection may remove the need for a riskier, more extensive surgery in the neural tissue of the thigh. The cysts may intrude into the spine, which may cause pain and

dysesthesia Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation" (abnormal sensation). It often presents as pain Joseph J. Marbach, Joseph Marbach hypo ...

in distant extremities. Cystic

adventitial The adventitia () is the outer layer of fibrous connective tissue surrounding an organ. The outer layer of connective tissue that surrounds an artery, or vein – the tunica externa, is also called the ''tunica adventitia''. To some degree, its ...

disease, in which a cyst occurs within the

popliteal artery The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches ...

near the knee, has been proposed recently to occur by an articular mechanism, with a conduit leading from the joint, similar to the development of ganglion cysts, that spreads within the peroneal nerve. Cysts that were compressing one or more nerves and causing bone erosions have been reported to occur near the

shoulder joint The shoulder joint (or glenohumeral joint from Greek ''glene'', eyeball, + -''oid'', 'form of', + Latin ''humerus'', shoulder) is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. ...

. Cyst_Profile2.JPG, Cyst on right wrist Ganglion Cyst on Foot.jpg, Cyst on dorsum of right foot Kyste420.jpg, Cyst on a finger Ganglion Cyst On Right Index Finger.jpg, Small cyst on right index finger Ganglion_cyst_lanced.JPG, small cyst on thumb lanced with red-hot needle File:Ganglion Cyst on the palmar side of the left wrist.jpg, Ganglion cyst on the palmar side of the left wrist

Causes

The most commonly accepted probable cause of ganglion cysts is the ''

herniation A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin herni ...

hypothesis,'' by which they are thought to occur as an out-pouching or distention of a weakened portion of a joint capsule or tendon sheath. This description is based on the observations that the cysts occur close to tendons and joints. The microscopic anatomy of the cyst resembles that of tenosynovial tissue. The fluid is similar in composition to synovial fluid. Dye injected into the joint capsule frequently ends up in the cyst, which may become enlarged after activity. Dye injected into the cyst rarely enters the joint, however, which has been attributed to the apparent formation of an effective and one-way "

check valve A check valve, non-return valve, reflux valve, retention valve, foot valve, or one-way valve is a valve that normally allows fluid (liquid or gas) to flow through it in only one direction. Check valves are two-port valves, meaning they have t ...

", allowing fluid out of the joint, but not back in. In synovials, post-traumatic degeneration of

connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...

and

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

have been considered as causes. Other possible mechanisms for the development of ganglion cysts include repeated mechanical stress,

facet Facets () are flat faces on geometric shapes. The organization of naturally occurring facets was key to early developments in crystallography, since they reflect the underlying symmetry of the crystal structure. Gemstones commonly have facets cut ...

arthrosis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...

, myxoid degeneration of periarticular

fibrous tissue Fiber or fibre (from la, fibra, links=no) is a natural or artificial substance that is significantly longer than it is wide. Fibers are often used in the manufacture of other materials. The strongest engineering materials often incorporate ...

s and liquefaction with chronic damage, increased production of

hyaluronic acid Hyaluronic acid (; abbreviated HA; conjugate base hyaluronate), also called hyaluronan, is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglycans ...

fibroblasts A fibroblast is a type of biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework ( stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells o ...

, and a proliferation of

mesenchymal cell Mesenchymal stem cells (MSCs) also known as mesenchymal stromal cells or medicinal signaling cells are multipotent stromal cells that can differentiate into a variety of cell types, including osteoblasts (bone cells), chondrocytes (cartilage cel ...

s. (original source cites eight additional references for the quoted paragraph)

Diagnosis

Ganglion cysts are diagnosed easily, as they are visible and pliable to touch. Radiographs in

anteroposterior Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

and

lateral Lateral is a geometric term of location which may refer to: Healthcare *Lateral (anatomy), an anatomical direction *Lateral cricoarytenoid muscle *Lateral release (surgery), a surgical procedure on the side of a kneecap Phonetics *Lateral cons ...

views should be obtained to exclude any more serious underlying pathology. Ultrasonography ( US) may be used to increase diagnostic confidence in clinically suspected

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

s or to depict

occult The occult, in the broadest sense, is a category of esoteric supernatural beliefs and practices which generally fall outside the scope of religion and science, encompassing phenomena involving otherworldly agency, such as magic and mysticism a ...

cysts, because intratendinous ganglia are readily distinguished from extratendinous ganglia during dynamic ultrasonography, as

microscopically Microscopy is the technical field of using microscopes to view objects and areas of objects that cannot be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of micr ...

, ganglionic cysts are thin-walled cysts containing clear,

mucinous Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It i ...

fluid.

Treatment

If persons are not in pain, they should simply be reassured that the lump is not cancerous, and wait for the lump to disappear on its own. At least 33% resolve without treatment within six years, and 50% within 10 years. Surgical treatments remain the primary elective option for treatment of ganglion cysts. The progression of ganglion surgery worldwide is to use an

arthroscopic Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the jo ...

or miniopening method. Alternatively, a

hypodermic needle A hypodermic needle (from Greek ὑπο- (''hypo-'' = under), and δέρμα (''derma'' = skin)), one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used w ...

may be used to drain the fluid from the cyst (via aspiration) and a

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involv ...

may be injected after the cyst is empty; however, if the fluid has thickened, owing to the passage of time, this treatment is not always effective. The recurrence rate is about 50% following needle drainage (via aspiration) of ganglion cysts. A historical method of treatment for a ganglion cyst was to strike the lump with a large and heavy book, causing the cyst to rupture and drain into the surrounding tissues. Historically, a Bible was the largest or only book in any given household, and was employed for this treatment. This led to the nickname of "Bible bumps" or "

Gideon Gideon (; ) also named Jerubbaal and Jerubbesheth, was a military leader, judge and prophet whose calling and victory over the Midianites are recounted in of the Book of Judges in the Hebrew Bible. Gideon was the son of Joash, from the Abiez ...

's disease" for these cysts. This treatment risks injuring the person and thus is not recommended.

Complications

Complications of treatment may include joint stiffness and scar formation. Recurrence of the

is more common following excision of a volar ganglion cyst in the wrist. Incomplete excision that fails to include the stalk or

pedicle Pedicle or pedicel may refer to: Human anatomy *Pedicle of vertebral arch, the segment between the transverse process and the vertebral body, and is often used as a radiographic marker and entry point in vertebroplasty and kyphoplasty procedures ...

also may lead to recurrence, as will failing to execute a layered closure of the incision.

Prognosis

Recurrence rate is higher in aspirated cysts than in excised ones. Ganglion cysts have been found to recur following surgery in 12% to 41% of patients. A six-year outcome study of the treatment of ganglion cysts on the dorsal wrist compared excision, aspiration, and no treatment. Neither excision nor aspiration provided long-term benefit better than no treatment. Of the untreated ganglion cysts, 58% resolved spontaneously; the postsurgery recurrence rate in this study was 39%. A similar study in 2003 of ganglion cysts occurring on the palmar surface of the wrist states: "At 2- and 5-year follow-up, regardless of treatment, no difference in symptoms was found, regardless of whether the palmar wrist ganglion was excised, aspirated, or left alone."

Etymology

Being a

misnomer A misnomer is a name that is incorrectly or unsuitably applied. Misnomers often arise because something was named long before its correct nature was known, or because an earlier form of something has been replaced by a later form to which the name ...

that has persisted into modern times, the ganglion cyst is unrelated to the neural "

ganglion A ganglion is a group of neuron cell bodies in the peripheral nervous system. In the somatic nervous system this includes dorsal root ganglia and trigeminal ganglia among a few others. In the autonomic nervous system there are both sympatheti ...

" or "

cell"; its etymology traces back to the ancient Greek γάγγλιον, a "knot" or "swelling beneath the skin", which extends to the neural masses by analogy. Generally,

Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...

is credited with the description of these cysts. The term "Bible cyst" (or "Bible bump") is derived from an

urban legend An urban legend (sometimes contemporary legend, modern legend, urban myth, or urban tale) is a genre of folklore comprising stories or fallacious claims circulated as true, especially as having happened to a "friend of a friend" or a family m ...

or historical effort to hit the cyst with a

Bible The Bible (from Koine Greek , , 'the books') is a collection of religious texts or scriptures that are held to be sacred in Christianity, Judaism, Samaritanism, and many other religions. The Bible is an anthologya compilation of texts of a ...

. Trying to treat the lesion by hitting it with a book, though, is discouraged.

References

External links

American Academy of Orthopaedic Surgeons - Ganglions cyst of the wrist
{{DEFAULTSORT:Ganglion Cyst Dermal and subcutaneous growths Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate