A Ganglion is a balloon that develops between the joint spaces, filled with fluid. It is not dangerous and mostly only painful when compressed between certain structures.
There is usually a stem where the balloon originates leading to a ball area where the fluid accumulates. Its able to move around and not very hard. You can squash it when you press on it, but it returns when you relieve the pressure.
Development of a Ganglion
Friction in the area causes a synovial bubble to form, this is the body’s natural way to repair the tissue. But as a result of this abnormal high amount of cells that rush to the area a bubble (filled with excess fluid) forms.
Between the connection of two bones in a joint are cushions, called cartilage. Between the two sides of the cartilage is a space made up of synovial fluid. The joint capsule is the confinement of this space. When too much fluid is present between these surfaces, it will create a bubble to one side (like compressing a balloon between your hands, one side will push out). This phenomenan is a ganglion.
Abnormal swelling in a joint after a fall onto your hand may over-stretch the joint capsule. When excessive amount of cells occupy the space between the joint, this may cause the capsule to form a weak spot where a ganglionic bubble will form.
Why is a Ganglion painful?
It can be painful when the ganglion pinches between the bony ends of the joint or it presses on the surrounding soft tissues like tendons, nerves and other pain sensitive structures.
Where does a ganglion form?
Mostly on the top of your wrist, where it usually develops between the carpal bones. Because the carpal bones don’t have much space to move and due to the close proximity of the bones to each other, the connecting surfaces do not allow much leeway as their tight arrangement together restricts movement. Technically it can develop at any joint throughout your body.
What does Synovial fluid normally do?
Synovial fluid is like a lubricant between the bones of a joint, like a car needs oil to keep the engine running smoothly, the joints needs synovial fluid.
How does a Ganglion Develop, or get worse?
It starts off as a small bump on the skin, that disappears sporadically, but as time progresses, you will find that the bump gets larger and may become painful with certain movements. The larger the bump, the more pain you are prone to experience.
The bump you see on the surface is merely a small representation of the underlying problem.
It takes a while to develop, anything between 4-6 months.
How does a Ganglion happen?
- Trauma, incident
- Excessive movement into a wrist bending motion
- Repetitive strain on the carpal joints
Symptoms of a Ganglion
- Bump over the skin
- Pain with certain movements, depending on where the balloon pops out
- Most patients complain more about the cosmetic look than pain.
If you press on it and it moves around, its more likely to be a ganglion. It is like when you press down on a ball under water and it seems to disappear, but when you release it, it will return to the surface. The ganglion will do the same.
I am an expert at feeling and distinguishing between different types of ganglions, seeing that I work with this type of problem every day. I will be able to reassure and confirm whether it is a ganglion after I have assessed it and in most cases no further tests are necessary and may be a bit excessive.
X-rays will be an unnecessary test as the bones and joints are still normal. No joint involvement is present. An x-ray will not be able to show the ganglion itself. So X-rays will be redundant in this case.
This is a very useful tool to see in detail the extent and size of the ganglion, but any skilled hand therapist will be able to diagnose a Ganglion without an expensive MRI. An unnecessary test to perform.
Sonar (Diagnostic Ultrasound):
A sonar can determine the size, thickness and degree of a ganglion. It will show the size and magnitude of the problem. This would be best way to assess a ganglion.
Does it heal by itself?
No. It is like the difficulty you experience when you start to blow up a balloon, but if you continue to blow or blow it up again, the balloon has already stretched and weakened making it easier. Likewise it is uncommon for a ganglion to resolve by itself. However, the size of the cyst/ganglionic sack may vary in size from time to time, only to return with exertion.
A big problem we see with ganglions these days:
After surgery , stiffness, abnormal scarring and hyper(excessive) sensitivity to the skin over the area is common.
Drainage or aspiration of the synovial fluid seems to be quite ineffective as the fluid tends to accumulate again in the same area. This causes the same problem to reoccur.
Surgery of Ganglion:
Surgical removal of the ganglion proves to be the best option, followed by a guided, progressive, strengthening and conditioning program – this is where I play a vital role.
Surgery involves a small incision on the wrist over the ganglion, the excessive membrane is severed and the bases tied together. A very simple, yet effective surgical procedure. The hand therapist will play a vital role in treating and guiding the scar tissue that forms after the surgery because abnormal scar tissue can cause stiffness in your wrist and limit you to do only certain movements. I am here to make sure this doesn’t happen.
After surgery the recovery time is expected to be between 3-4 weeks for you to have normal movements, with no limitation using your hand.
Ganglion also Known as:
- Ganglionic Cyst
- Bump on wrist
Gout vs Ganglion
The most similar bump on the skin can be either caused by Gout or a synovial ganglion, where the main distinguishing factor is that Gout is a crystal deposit that is much harder and a ganglion is much more movable under the surface of the skin.
What else could the pain be?
- Carpal Bone Fracture
- Radio-Ulnar joint instability
What needs to be tested to determine the source of your hand pain
Range of Movement
Nerve tension test
Tendon gliding test