From the Guidelines
Ganglion cysts are best diagnosed with MRI or US, as these imaging modalities can accurately identify fluid-filled and synovial-lined structures, including ganglia, cysts, bursa, and tendon sheaths 1. When it comes to diagnosing ganglion cysts, the choice of imaging modality is crucial. The American College of Radiology recommends using MRI or US as the initial diagnostic imaging method for suspected ganglion cysts, especially when radiographs are nondiagnostic 1.
Key Points to Consider
- Ganglion cysts are noncancerous fluid-filled lumps that typically form along tendons or joints, most commonly on the wrist, hand, ankle, or foot.
- Many ganglion cysts cause no symptoms and require no treatment, especially if they're small and painless.
- However, if a cyst causes pain, interferes with joint movement, or creates cosmetic concerns, treatment options include observation, aspiration (draining the fluid with a needle), or surgical removal.
- US is a useful technique for examining extra-articular soft tissues, such as suspected ganglion cysts, and its accuracy is similar to that of MRI 1.
- US can also be used to diagnose abnormalities of the flexor and extensor tendons and tendon sheaths, and to guide therapeutic intra-articular and other soft-tissue injections 1.
Diagnosis and Treatment
The most appropriate next step in diagnosing a suspected ganglion cyst is to use MRI or US, as these modalities can provide accurate diagnoses and guide treatment decisions 1. In patients with suspected ganglion cysts, US examination can identify erosions and active synovitis, findings that influence early diagnosis and treatment decisions 1. For painful cysts, over-the-counter pain relievers like acetaminophen or ibuprofen may help manage discomfort. While some people try home remedies like pressing a book on the cyst, these methods aren't recommended as they can damage surrounding tissues. Ganglion cysts form when joint or tendon fluid leaks into a small sac that develops from the joint lining or tendon sheath. Though they may disappear on their own, they can recur even after treatment, particularly after aspiration.
From the Research
Ganglion Cyst Overview
- Ganglion cysts are soft tissue swellings that occur most commonly in the hand or wrist 2, 3.
- They can be asymptomatic, but other symptoms include pain, weakness, or paraesthesia 2.
- The two main concerns patients have are the cosmetic appearance of the cysts and the fear of future malignant growth 2.
Treatment Options
- Treatment can be either conservative or through surgical excision 2, 4.
- Nonsurgical treatment is largely ineffective in treating ganglion cysts, but can provide symptomatic relief 2.
- Surgical interventions have a lower recurrence rate, but a higher complication rate with longer recovery period 2, 4.
- Arthroscopic excision has shown promising results, but open excision remains the gold standard 3.
- Aspiration and steroid injection can reduce the volume of the cyst, but the effect wanes off progressively over time 5, 6.
Recurrence Rates
- 58% of cysts will resolve spontaneously over time 2.
- 50% of cysts will spontaneously resolve 4.
- Cyst aspiration/injection is fraught with a high incidence of recurrence, with rates between 8 and 74% 4, 6.
- Surgical treatments seem to have better results, with less disparate failure rates, at around 15% 6.
- Recurrence rate after a first injection was 73.2% with a mean follow-up of 34 months 6.