Synovial cyst, overbone

A clearly visible lump usually forms on the wrist, sometimes also on the foot, knee or finger: a ganglion. Traditionally, this condition is often referred to as overleg, but this is not actually the case. This is not an ossification, but a fluid-filled pocket.

What is a ganglion?

A ganglion does not cause any malignant symptoms and is mainly disturbing in appearance. In many cases, the ganglion disappears on its own after a while. However, if it hurts or hinders movement, we can also remove it.

A ganglion occurs on a joint capsule or tendon sheath, but much more frequently on the joint. The joint is surrounded by a connective tissue, the joint capsule, which is filled with fluid. If this connective tissue does not hold well, fluid may leak out and a ganglion may form. This gelatinous fluid consists of mucilage and hyaluronic acid. The ganglion is still connected to the joint capsule via a narrow connection and can therefore hardly be moved on the arm or foot. It can usually be clearly felt and seen under the skin. In rare cases, however, such a cyst can also form on the wrist without being visible from the outside. Then only pain points to this ganglion. A ganglion rarely develops on a tendon sheath.

Wrist of a woman with a ganglion

A ganglion grows very slowly and in many cases is no bigger than a pea. In contrast to a malignant tumor, the benign overleg does not cause any major damage, even though it is a soft tissue tumor. The ganglion is harmless. However, it can happen that a ganglion presses on a nerve. This causes pain or even numbness in the affected part of the body. In such a case, we will remove the excess leg. If an affected person has no symptoms, it usually makes sense to wait and see. Under no circumstances should those affected try to remove the ganglion themselves: The risk of inflammation is high and the likelihood of success is low. This is because ganglia tend to form again immediately after removal.

Ganglion: frequency and age

A ganglion is more likely to occur in younger people. It usually develops between the ages of ten and 50, most frequently in young people between the ages of 20 and 30. Women are three times more likely to discover a ganglion in their joints than men. This is because they have weaker connective tissue. In two thirds of all cases, this cyst forms on the upper side of the wrist. Theoretically, ganglions can develop in all joints. However, finger joints are usually affected in addition to the wrists. Sometimes these overlegs develop in different parts of the body at the same time.

Ganglion: causes and risk factors

The joint capsule encloses the two parts of a joint and contains fluid so that the joint can move easily. In the case of a ganglion, the joint produces too much fluid. This causes the connective tissue of the joint capsule to bulge out to create space. This creates a ganglion. However, why some people develop too much joint fluid has not yet been conclusively clarified. However, experts suspect the following causes:

  • previous joint trauma, for example due to a dislocation, dislocation or torn ligament
  • Osteoarthritis: natural wear and tear
  • Rheumatic diseases, gout: they often lead to increased production of synovial fluid
  • Inflammation of the joint
  • Excessive strain, for example during unusual sporting activity or monotonous movement (e.g. manual work)

Symptoms: Ganglion is particularly visually disturbing

The lump is conspicuous and usually appears on the wrist, sometimes on the fingers or foot and very rarely on the shoulder or elbow. It can reach the maximum size of a cherry, but often remains smaller. However, it does not feel hot, as an overleg is not inflamed. In rare cases, a ganglion can grow quite quickly, but usually slowly over several weeks or months. In most cases, pressure causes pain. Some sufferers also have pain all the time or only when moving the joint or bending it strongly. Others feel nothing at all and regard the ganglion as a purely cosmetic problem.

Other complaints that can be caused by ganglions in rare cases:

  • Pain in the upper arm: If nerves or blood vessels are pinched by the thickening, the pain can radiate to the entire arm.
  • Numbness: A feeling of numbness in the affected limbs can also occur in this case. Some sufferers also experience this as a tingling sensation.
  • Deformed nails: If a ganglion forms at the finger end joint, it can affect the nail root and lead to deformed nails.
  • Restriction of mobility: Depending on the exact location of the ganglion, the mobility of the joint may also be restricted.
  • Less grip strength: Especially with ganglions on the finger, those affected often have problems gripping.

Ganglion: Diagnosis with us

In most cases, the ganglion is clearly visible and palpable from the outside. We will feel whether it is a solid nodule or a fluid-filled cyst. We also test whether the joint can be moved normally or whether it causes pain in a certain position or flexion. We also examine whether the swelling has an influence on the blood flow to the affected part of the body.

We use an ultrasound examination to check whether the lump is really a ganglion and not a malignant tumor, a hemangioma or a lipoma. If we fear that joint wear has caused the ganglion, we will order an X-ray. If the affected person complains of pain in the joint without being able to see or feel anything from the outside, we sometimes also consult an MRI scan (magnetic resonance imaging). This gives us an even more precise picture of the joint. If you have such cysts in several parts of your body, please let us know.

Ganglion: prevention, early detection, prognosis

You can do a lot yourself to prevent a ganglion. Balanced exercise is important, in which all the joints of the body are regularly exercised. At the same time, you should avoid excessive and one-sided strain on individual joints, for example when doing manual work or certain sports. After sports and accident injuries such as torn ligaments, sprains or torn tendons, you should cure them thoroughly and consult us if in doubt. For typical joint wear and tear diseases such as osteoarthritis, it is advisable to follow our advice.

If you work a lot at a computer, you can also prevent ganglions: the tension on the wrist can promote ganglion formation. You should therefore ensure that you have a straight posture in front of the keyboard with an optimal hand and arm position. In between, you should include short relaxation exercises, such as targeted stretching exercises and loosening up your arms and fingers.

Course and prognosis of a ganglion

In many cases, a ganglion heals on its own after some time. But regardless of whether it disappears on its own, is punctured or operated on: The risk of a ganglion returning at some point (development of a recurrence) is high. Around a quarter of all ganglia form again in the same place over time. The best way to prevent this is if the cause is clear – such as a disease in the joint that can be treated. However, as in most cases no clear cause can be identified, it is not possible to prevent the recurrence of a ganglion.

A dressing protects the wound after an operation. However, you may use the hand or the affected body part again immediately as long as there is no pain. Sometimes patients undergoing surgery are also given a splint to immobilize the joint after the operation and thus reduce the pain. You should rest the joint during the initial period after a puncture or operation. After about four to six weeks you can put full weight on it again. If the flexion of the joint is restricted, exercises that a hand therapist can show the affected person can help. You should do this regularly at home.

Treatment of a ganglion

If the affected person is not in pain, we recommend that they wait and see. This is because many ganglia regress on their own after some time. Treatment is rarely necessary, especially in children. However, if pain occurs, we recommend treatment.