Ganglion Causes and Treatment
A hard lump that develops on a tendon on the back of the hand, or less commonly on the top of the foot, is most likely to be a ganglion. The term ganglion is a confusing one in medicine, because it also refers to the microscopic connections between nerve fibers. The ganglions referred to here usually have nothing to do with nerves; they are thin-walled cysts that are filled with a thick, clear fluid.
Tendons slide backwards and forwards as muscles contract and relax. Around the wrist and ankle, they are confined within fibrous tubes called tendon sheaths. The sheaths prevent the tendon from slipping out of position around the joint, and from raising the skin excessively when the wrist or toes are bent back. The solid tendon is surrounded by a thin film of lubricating fluid within the tendon sheath. The ganglion is attached to this sheath that surrounds the tendon. One theory to explain their cause is that there is a small puncture in the tendon sheath which allows some of the lubricating fluid around the tendon to escape and form a firm lump under the skin. Ganglions may also form as attachments to joints within the wrist.
Ganglions are not dangerous, and they usually cause no problems other than being unsightly and uncomfortable. Occasionally, the ganglion may press on a nerve and cause pain and/or weakness in the hand or finger beyond that point. Very occasionally they may become infected, and as this infection can spread into the tendon, it must be treated rapidly and effectively.
The traditional treatment of a ganglion was to place the hand flat on a hard surface and hit it firmly with the family Bible, as they were the biggest heaviest book in the home. This usually caused the cyst to burst and disappear. This form of treatment can no longer be recommended, as the ganglions tend to come back, a local inflammatory reaction can occur at the site of the burst ganglion, and the hand may become quite bruised.
The more orthodox treatment involves a minor operation in which the ganglion is cut away from the tendon or joint to give a permanent cure. Another treatment method involves inserting a needle into the gangloin, withdrawing the thick fluid in it, and injecting back a small amount of a steroid solution that often prevents the ganglion reforming.
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