Synovial (Ganglion) cyst

The synovial cyst or ganglion cyst is one of the most frequent (pseudo-tumoral) growths of soft tissues that appears on the upper limbs, in multiple locations, most commonly at the radiocarpal joint (dorsal face of the wrist).

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Of soft, semi-solid consistency when touched, the ganglion cyst is caused by an accumulation of articular or synovial fluid, encased by connective tissue, and presents as an expansion of the articular capsule or synovial tendon, from which it originates. Therefore, there may be joint or tendon cysts. The causes of the onset of synovial cysts are manifold:

• repeated local trauma;
• activities that put significant strain on the small joints of the hand;
• ligamentous hyperlaxity;
• arthritis – commonly encountered and of major size in rheumatoid arthritis;
• spontaneous, without a specific cause.

Symptomatology varies depending on the location of the ganglion cyst and its size, from aesthetic deficiency of the growth that deforms the anatomical regions to pain, paresthesia (tingling) and hypoesthesia (numbness) when they press on the branches of the nerves that enter the joint or deep cyst, and functional impotence with muscle weakness. Cysts that are large in size are a concern because of the risk of cell transformation and the compression syndromes they may generate. Depending on the associated symptomatology, certain paraclinical investigations can be recommended, such as: X-ray, soft or joint ultrasound, MRI, etc.

Treatment

Nonsurgical:

• growth monitoring;
• decreased use of the joint, up to having it immobilized with special splints / braces for a certain period of time;
• Massaging the growth – which may cause its temporary disappearance, and later reappearance when resuming movements of the wrist.

Surgical: Cyst aspiration (drainage) – is a temporary solution and with a very high risk of recurrence of the cyst, because it has not resected its encasing and has not surgically closed the gap in the joint or tendon that fills the cyst with synovial fluid. Excision – is performed under local anesthesia. Both the cyst is resected, along with closing the joint or tendon, and the capsular continuity is restored. Thus, with proper surgical treatment and postoperative recovery, the risk of recurrence is minimized.

Postoperative recovery

• Immediately after the surgery, you will have a bulky bandage or even a splint or brace, so that you won’t be able to move your wrist;
• You should resume normal movements of the joint as soon as you can tolerate them;
• You will have no removable wires, only some surgical adhesives. Their removal is performed 14 days after the surgery;
• Any pain that appears postoperatively will be treated with non-steroidal anti-inflammatory drugs;
• Edema is normal in the operated area and will be reduced by cold packs (cold gels, ice packs, cold compresses)
• The recovery depends on the size of the cyst and on the pre-operative symptoms (numbness, functional impotence, etc.).