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Treatment myths of ganglion cysts: Is surgery really necessary?
A ganglion cyst is a fluid-filled swelling associated with a joint or tendon sheath. The most common location is the back of the wrist, followed by the front of the wrist. Although its cause is still unclear, its formation mechanism is thought to involve herniation of the synovium. The diagnosis is usually based on clinical examination, with confirmation of the diagnosis aided by radiographic examination of the mass or by historical reduction in size. Most ganglion cysts are obvious on observation, but medical imaging may be considered in a few cases to exclude alternative diagnoses.
Treatment is not always necessary; about half of ganglion cysts go away on their own.
According to research, approximately 3 in 10,000 people develop a new ganglion cyst in the wrist or hand each year. Among the various locations of ganglion cysts, cysts near the wrist joints are the most common, especially in the navicular joint area. Common wrist ganglion cysts include dorsal ganglion cysts, palmar ganglion cysts, and cysts of the extensor tendon of the digitorum.
Main causes of ganglion cysts
Currently, the most accepted explanation for ganglion cysts is the hernia hypothesis, which holds that ganglion cysts occur because a weak part of the joint capsule or tendon sheath protrudes outward. This view is based on the observation that ganglion cysts occur close to tendons and joints. The microstructure of the cyst is similar to that of synovial tissue, and the composition of the fluid is also similar to that of synovial fluid. Experiments have found that dye injected into the joint usually enters the cyst, while dye injected from the cyst rarely flows back into the joint, which may be attributed to the formation of an effective one-way "check valve".
Diagnosis and treatment
Ganglion cysts are relatively simple to diagnose because they are very obvious in appearance and are tender to the touch. Ultrasonography is sometimes used to improve the diagnostic confidence of clinically suspected lesions. Although ganglion cysts sometimes go away on their own, treatment options include draining the fluid from the cyst with a needle or surgical removal. According to research, at least 33% of ganglion cysts will disappear on their own within six years, and 50% of cysts will disappear within ten years.
Studies have shown that surgical removal or extraction is not necessarily better than no treatment, and 58% of untreated cysts will disappear on their own.
Although surgical resection is the main option, it is necessary to note that the recurrence rate after surgery is still high. Whether it is resection or extraction, the recurrence of ganglion cysts is between 12% and 41%. Many people question whether it is really necessary to take the risk of surgery?
Surgery and Complications Considerations
Given the recurrence of ganglion cysts, the approximately 50% recurrence rate, and the risk of joint stiffness and scarring, is surgical removal really necessary? Some studies have suggested that the initial bedside diagnosis above the knee should not usually be made immediately as a ganglion cyst because these growths may be other lesions.
ConclusionThe existence of ganglion cysts is not only confusing in appearance, but the decision on whether to undergo surgery is also full of myths and challenges. As the condition becomes better understood, there seems to be increasing evidence that nonsurgical treatment can be an appropriate option. Faced with the possible relatively high recurrence rate and the possible complications, perhaps readers need to think deeply about whether you really need surgical treatment to solve this problem?
