ΓΑΓΓΛΙΟ - ΓΑΓΓΛΙΑΚΗ ΚΥΣΤΗ

GANGLION – GANGLIAN CYST

Γεώργιος Δ. Γκουδέλης

Γεώργιος Δ. Γκουδέλης
The ganglion cyst is the most common benign clinical entity that concerns in the wrist area, on the dorsal or palmar surface of the wrist.
This cyst contains a transparent gel, which comes either from the joints of the wrist bones, or from the tendon sheaths of the hand.
The size of the cyst can change over time and with the person’s activity (manual work).
It can also appear in other parts of the knee such as the fingers, foot and knee.

ETIOLOGY

The etiology of the disease has not been fully clarified to date. It occurs more often in people who have manual activity but can also appear
in people who do not particularly strain their upper limb. In patients suffering from autoimmune diseases (rheumatoid arthritis, gout, etc.), the incidence of ganglion is higher than average.

CLINICAL PICTURE

There are three main concerns for the person suffering from a ganglion cyst.

  • Whether the cyst can be associated with malignancy
  • Pain and perhaps numbness in the wrist and hand
  • The aesthetic factor, especially in women if the ganglion is large

A ganglion is not necessarily a painful condition. Palpation and pressure may cause pain in the area, but this mainly occurs if the cyst is in anatomical connection with nerve trunks.

Γεώργιος Δ. Γκουδέλης
Large ganglion cyst on the dorsal surface of the wrist. The ganglion, in addition to the pain it causes to the patient, is also an aesthetic problem.

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CONSERVATIVE TREATMENT

Therapy

Conservative treatment usually involves resting the hand and avoiding weight-bearing for a period of 20-40 days. This can reduce the size of the cyst.
Applying a special splint can help reduce the size of the ganglion because it essentially limits the activity of the carpal tunnel, but this cannot actually cure the problem.

Aspiration of the ganglion cyst gel with a needle can reduce the size of the ganglion, but relapse to the initial levels is rapid, so it is not an official treatment suggestion.

OPERATIVE TREATMENT

Therapy

Surgical treatment using microsurgical techniques is the essential therapeutic approach to solving the problem.

1st CASE


Large ganglion on the dorsal surface of the wrist in a young woman.


Microsurgical preparation of the large ganglion which comes into close contact with a branch of the radial nerve, a fact that causes numbness and pain in the wrist and hand. The ganglion cyst is separated from the nerve and removed en block. In the photo, the forceps hold the nerve trunk and the oversized cyst is clearly visible below it.


The ganglion has been removed. The nerve trunk is kept intact.

Before and after microsurgical removal of ganglion cyst of the wrist

2nd CASE

A 60-year-old patient with a large ganglion cyst on the dorsal surface of the wrist and hand.



Hypertrophic walls of the ganglion cyst (ganglion), which are removed thoroughly.


The walls of the ganglion cyst (ganglion) after their removal.



Clinical image of the hand after ganglion removal


Before and six months after the microsurgical removal of the ganglion from the dorsal surface of the wrist

3rd CASE


Ganglion on the palmar surface of the wrist. The anatomical peculiarity of the area is that the radial artery (one of the two main arteries of the hand) is located below and next to the ganglion cyst.

Microsurgical preparation of the ganglion


Resection of the ganglion after removing its contents


Ganglion cyst – ganglion

The microsurgical procedure is performed under general anesthesia or anesthesia of the upper limb that hosts the cyst. The duration of the procedure does not exceed 30-40 minutes and the patient returns home the same day without the need for hospitalization in the clinic. We avoid local anesthesia because in case of insufficient removal of the ganglion, the recurrence rates are high.
Postoperatively, there must be a period of rest of the hand for a period of approximately 20 days. In manual workers, it may take 30 days.

Today, the improvement of surgical techniques – microsurgery and the use of optical intensifiers – microscopes (surgical loops), definitively addresses this frequent problem.

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Γεώργιος Δ. Γκουδέλης
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