Ganglionic Cyst

Summary

Ganglionic cysts (ganglion cysts) are fluid-filled cysts that are common on the lateral aspect of the ankle and on the top of the foot. Clinicians and surgeons believe that ganglionic cysts are derived from weakened areas of tendon sheath. The weakening in the tendon sheath allows for herniation of the fluid within the tendon sheath out into free space forming a fluid-filled cyst. Ganglionic cysts are not specific to the foot and are found at other locations in the body, particularly the wrist. Ganglionic cysts affect men and women equally and are commonly found between the ages of 25 and 60 years.

Symptoms

• Subdermal, fluid-filled cysts that vary in size
• May be asymptomatic or painful if compressed by a shoe or directly under a nerve
• No erythema (redness) or bruising is found

Description

Ganglionic cysts are also known as Bible cysts or Gideon's cysts. These names are derived from the historical practice of treating the cyst by rupturing it with a heavy book such as a Bible. Ganglionic cysts are also sometimes called synovial cysts. Ganglionic cysts and synovial cysts are very similar in their presentation and clinical appearance, but differ in their origin. Ganglionic cysts are derived from tendon sheath while synovial cysts are derived from the lining of a joint (synovium).

Causes and contributing factors

Although there is no consensus in the literature, most authors agree that ganglionic cysts are due to trauma to the tendon sheath.  Trauma to the sheath results in loss of integrity of the sheath and the ability for fluid to herniate into free space.

Differential diagnosis

Arthritis
Benign tumor
Malignant tumor
Synovial cyst

Treatment

If asymptomatic, many patients choose to ignore a ganglionic cyst. If the ganglionic cyst becomes painful, treatment options include aspiration of the cyst or surgical excision. Aspiration of a ganglionic cyst is a common office procedure. Following aspiration, a steroid injection is often used to fill the cyst. Steroid is used in an attempt to scar the pedicle of the cyst to destroy the communication between the ganglionic cyst and the tendon. Aspiration of ganglionic cysts with instillation of steroid is a common practice, but only successful in about 50% of cases.(1)

Surgical excision of a ganglionic cyst has a higher success rate (85-90%) compared to aspiration of the cyst (2,3), but surgical excision of a ganglionic cyst does carry with it the cost and potential complications associated with surgery. The following steps show the excision of a ganglionic cyst on the lateral aspect of the foot. This ganglionic cyst was excised due to the patient's inability to fit into an enclosed shoe. Depending upon the size and location of the ganglionic cyst, most patients can bear weight on the foot immediately following surgery. Excision of a ganglionic cyst can be completed in approximately 30 minutes and is performed with either a general anesthetic or local anesthetic with sedation. Recovery time and return to activities depends upon the success of the surgery and the extent of the dissection needed to excise the cyst.

When to contact your doctor

Ganglionic cysts that become symptomatic should be evaluated by your podiatrist or orthopedist.

References

1. Pocket Guide to Musculoskeletal Diagnosis. Springer. 2005. p. 63.

2. Gallego S, Mathoulin C. (2010). "Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years". Arthroscopy 26 (12): 1675–1682.

3. Lidder S, Ranawat V, Ahrens P. (2009). "Surgical excision of wrist ganglia; literature review and nine-year retrospective study of recurrence and patient satisfaction". Orthop Rev 1 (1): e5. doi:10.4081/or.2009.e5

Author(s) and date

This article was written by Myfootshop.com medical advisor Jeffrey A. Oster, DPM.

Competing Interests - None

Cite this article as: Oster, Jeffrey. Ganglionic Cyst  https://www.myfootshop.com/article/ganglionic-cyst

Most recent article update: December 10, 2020.

  Ganglionic Cyst by Myfootshop.com is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.