FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SURGERY PREFERRED OVER "BOOK BASHING" FOR WIFE'S GANGLION CYST

Question: My wife has seen an orthopedic surgeon because of a bump on her wrist. He diagnosed the condition as a ganglion cyst and wants to operate to remove it. What is a ganglion cyst, and is surgical removal the only treatment for it?

Answer: A ganglion cyst is a fluid-filled benign swelling of joint tissue. It can affect either the sheath that encircles a tendon or the tissues that surround a joint that is known as the "joint capsule".

I couldn't locate statistics about the prevalence of ganglion cysts, but from my personal experience, I can say that they are quite common. I see patients every week who are concerned about a new "bump" that has appeared on their wrist or near other joints. These bumps may be totally painless, or they can be quite uncomfortable. Pain is caused by the pressure these bumps place on nearby sensitive structures, such as the nerves of the carpal tunnel in the wrist or the nerves that leave the spinal column in the back.

A ganglion cyst occurs because of degenerative changes. That is, they happen as a consequence of wear and tear upon joints or tendons. As a response to repeated mild injury, usually occurring over a number of years, the supportive and protective lining of the joint or to the tendon sheath begins to swell in a "balloon-like" manner. The neck of the balloon connects to the joint capsule or tendon sheath and the body of the balloon stretches into the surrounding tissue forming a bump like the one on your wife's wrist.

A ganglion cyst can simply be left alone, if it is causing no problems. On the other hand, this type of cyst may require treatment if its physical size or location results in pain or interferes with normal joint function. Sometimes, these cysts - if not treated - can lead to more serious problems if they begin to put excessive pressure on nerves or blood vessels. This is an especially likely scenario if the cyst is in the wrist or spinal area. A ganglion cyst can also be treated if the "bump" is cosmetically unacceptable but otherwise causing no serious problems.

Cysts that require treatment can be cared for in several ways. Old time doctors, according to the stories I've heard, would smash a large book, preferably Gray's Anatomy, against the cyst hoping to break it. The theory was that once the cyst was broken it would not reform. This approach, unfortunately, usually produced wrist injuries without really helping treat the cyst.

Today, some physicians attempt to drain the cyst with a syringe. This is usually difficult because the fluid in the cyst is quite thick, and simply draining the cyst usually fails to provide lasting relief. Medication can be injected into the cyst after an attempt to drain it has been made. This method can be very successful, depending upon the size and location of the cyst, the type of medication injected into the cyst, and the skill of the physician. Many cysts, however, must be surgically removed, just as the orthopedic surgeon suggested for your wife.

How does your wife determine the best treatment for her ganglion cyst? She should talk to your family doctor and the orthopedic surgeon about the benefits and risks of the different methods. Then, once she is well informed, your wife can make her choice.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.