Introduction
Ganglion cysts are treated by needle aspiration, excision, and arthroscopic excision. Surgery of the ganglion cysts is carried out in patients in whom conservative approaches have failed, and they present with recurrent symptoms. These are associated with specific recurrence rates. The recurrence rate from needle aspiration is between 60 to 95 percent, 1 to 50 percent from surgical excision, and 8.5 to 30 percent from arthroscopic resection. Open excision is found to have a much greater recurrence rate. Several studies have been carried out to assess the ganglion cysts' recurrence rate after excision and re-excision.
What Are Ganglion Cysts?
A cyst is a fluid-filled pocket that can develop in various body parts, such as the skin or internal organs. The size of the cyst varies from small to big, filled with a large volume of fluid. A ganglion cyst is a fluid-filled sac present over a joint in a tendon in the wrist or hand. A tear in the tissues covering a joint or tendon leads to a bulging of the tissues forming a sac. These cysts commonly affect the hand and wrists. These cysts are non-cancerous but can cause symptoms like weakness, pain, or functional loss due to irritation of the nerve and tissues. The cause of ganglion cysts remains unclear. These cysts can heal on their own and are not fatal. The treatment of ganglion cysts includes non-surgical approaches such as needle aspiration.
What Are the Symptoms of Ganglion Cysts?
Ganglion cysts are usually asymptomatic and heal on their own. However, if symptoms are present, it is mostly the presence of a lump or growth on the wrist, hand, ankle, or foot. A ganglionic cyst on the foot may give rise to pain while walking.
A cyst adjacent to a nerve can lead to the following symptoms:
What Causes Ganglion Cysts?
The cause of ganglion cysts is unknown. According to some studies, a cyst might develop after an injury or trauma. This leads to the bulging out of the tissues. While others believe ganglion cysts that ganglion cysts originate from the mesenchymal cells present at the synovial capsular junction after an injury. recurrent injuries to the supporting structures stimulate the fibroblasts to secrete hyaluronic acid, producing a jelly-like substance found in the ganglion cysts.
What Risk Factors Lead to the Formation of Ganglion Cysts?
Ganglion cysts can occur in anyone. However, the chances of them occurring in individuals aged 15 to 40 years is more. They are more commonly found in women than men. They occur frequently in individuals who tend to injure their wrists repeatedly, like gymnasts.
Factors that increase the risk of developing a ganglion cyst include the following:
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Joint swelling.
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Recurrent injury to the wrist or finger.
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Injury to the wrist or finger.
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Arthritis (inflammation of the joints).
Why Is There Recurrence of Ganglion Cysts Following Re-Excision?
Tumors present on the hand are approximately 95 percent benign or non-cancerous. About 60 percent of these benign tumors are ganglion cysts. It has been suggested that the ganglion develops due to the degeneration of the connective tissues, especially collagen. 60 to 70 percent of these are found in the wrists and hands. This can lead to limitation of movement, weakness, and joint instability.
The median nerve (the nerve that helps move the forearm, wrists, hands, and fingers) can get compressed when a ganglion arises in the carpal canal (the passage from the wrist to the hand). A ganglion on the wrist's ulnar side can compress the nerve (the nerve that transmits electrical signals to the forearm and hand), leading to pain and paresthesia.
Surgery is required in such cases for better outcomes with lesser complications. Many non-surgical treatment modalities have been developed for the treatment of ganglion cysts. Arthroscopic excision of the ganglionic cysts successfully removes dorsal ganglion cysts.
The recurrence of the ganglion cyst occurs mostly on the palm or sole of the hand or wrist. The symptoms on the palm or sole of the hand are less tolerated than on the other side. Ganglion cysts of the palm and wrist are difficult to treat surgically as there is a risk of damage to the radial artery, and the location of the stalk of the cyst is quite difficult. The rate of recurrence is three out of twenty individuals.
The time of recurrence of ganglion cysts after the surgical excision ranges from a month to a year. The average recurrence time is around 2.5 years. In a study, three individuals had a re-recurrence after the second ganglion cyst was removed. These three individuals had a ganglion cyst in the sole, palm, or wrist. The recurrence occurred within a year of the procedure.
In another study, the recurrence rate post open ganglion cyst surgery is 3.8 percent. The pooled rate of recurrence was reported in the range of 4 to 20 percent for open surgery. The reason for the reduced rate of recurrence needs to be understood properly. The surgeon's experience and the male gender are considered the two causes of recurrence in some studies. Some studies found higher rates of complications in idiopathic scoliosis surgery done by less experienced surgeons.
What Are the Limitations of the Studies Related to the Recurrence of Ganglion Cysts Following Re-Excision?
These studies have some limitations. It could be possible that individuals with recurrence did not undergo treatment. A recurrent ganglion cyst and a new cyst that formed close to the surgically excised cyst could be difficult to identify. This could lead to a false estimation of the recurrence rate in such studies.
Conclusion
Ganglion cysts are non-cancerous fluid-filled growths with a higher prevalence in women. These may develop in any upper limb joint, the wrist being the highest percentage. Around 70 percent of these cysts are found on the dorsal side of the wrist, whereas 20 percent occur on the palm or sole (volar side) of the wrist or hand. They are usually asymptomatic and are associated with pain and weakness.
Most of these lesions resolve on their own. The treatment is usually opted for because of pain or due to cosmetic reasons. The different treatment modalities are non-surgical interventions like aspiration, open surgery, and arthroscopic excision. An understanding of the complications and rates of recurrence is important for consent.
The patients should be informed about the risk of recurrence after re-excision of the ganglion cysts. Further research should be carried out regarding the recurrence of ganglion cysts post-re-excision.
