Disease Description (Causes and Symptoms)

Definition: A ganglion is a benign cystic mass that develops from the joint capsule or tendon sheath around the wrist (back or palm of the hand), finger joints, ankles, and other areas. It is filled with clear, sticky joint fluid (mucous material).
Cause/pathophysiology: The exact cause is unknown, but it is thought to result from degenerative changes in the joint capsule or the sheath surrounding a tendon, leading to the production of mucus and cystic expansion. It often has a stalk connecting it to the joint.
Main symptoms:
- A round or oval lump that can be felt just beneath the skin
- Usually painless, but depending on its size or location, it may cause pressure, localized pain, or restricted movement
- A ganglion on the back of the hand becomes more prominent when the wrist is bent
- Rarely, if located around a blood vessel or nerve, it may be accompanied by a pulsating sensation, tingling, or severe pain
Clinical features: The size varies from as small as a pea to as large as a chestnut, and it may become larger or smaller depending on use (such as wrist use). It may disappear spontaneously.

Treatment Methods

Conservative treatment (first-line when symptoms are mild):
- Observation (for no symptoms or minimal discomfort)
- Activity modification (reducing activities that trigger symptoms)
- Wearing a wrist brace (temporary stabilization)
Nonsurgical procedures:
- Needle aspiration: A syringe is used to remove the mucous fluid, which may relieve symptoms; however, because the cyst remains, the recurrence rate is high. Steroids may sometimes be used in combination when necessary, but this is not a definitive treatment.
Surgical treatment:
- Excision (surgical removal) of the cyst, including the stalk connecting the cyst and part of the causative joint capsule. This may be considered when there is severe pain, functional limitation, or repeated recurrence.
- Possible postoperative issues include scarring, joint or tendon damage, and recurrence (the postoperative recurrence rate varies by institution and study but is lower than with nonsurgical treatment).
Medication: There is no medication that is specifically effective (general anti-inflammatory analgesics are used to relieve pain).
Prognosis and precautions:
- Most are benign and are not life-threatening.
- Because rapid recurrence may occur after aspiration, repeated aspiration is not recommended.
- Rarely, nerve or blood vessel damage, joint stiffness, or infection may occur during surgery.
- Weight, work, and activity modification and wound care are necessary before and after the procedure.

Items to bring to the clinic (recommended):
- A list of currently used medications (including anticoagulants and antiplatelet agents)
- Records of previous surgeries and trauma
- Results and images from previous tests (radiographs, ultrasound, MRI), if available (CD/USB or photographs)
- Notes or photographs documenting when symptoms began, changes in size, and the degree of pain (photographs taken over time can be useful)
Information useful to record before the visit:
- Frequency and intensity of pain (pain score) and which movements make it worse
- Whether symptoms limit daily life or occupational activities
Tests that may be performed at the clinic:
- Evaluation by visual inspection and palpation; if necessary, ultrasound or X-ray/MRI to check the soft tissues and connection to the joint
- Observation of color and viscosity during aspiration (diagnostic aspiration)

Is there a possibility that this ganglion is malignant (cancerous)?
Do you think treatment is necessary in my current condition? Is it okay to observe it?
Which method do you recommend, aspiration or surgery? What are the advantages and disadvantages and the recurrence rates?
What complications can be expected from surgery, and approximately how long will recovery take (return to daily life/work)?
What is the risk of scarring or reduced joint function after surgery?

Which structure is my ganglion connected to in the wrist (or finger/ankle)—the joint or the tendon sheath? Does that part also need to be removed during surgery?
I previously underwent aspiration, but it recurred. How much does the likelihood of recurrence decrease if it is removed surgically (the expected recurrence-rate range)?