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Swollen leg
Swollen leg

Should I remove this swelling?

Dear Mirror Doctor, Please, I have been diagnosed with ganglion on my right wrist a month ago. I am supposed to have surgery for it.
Please is it necessary to go through the operation?
Gloria.

Dear Gloria, Ganglion cysts are the most common swellings of the hand and wrist. Although anyone can be affected by ganglion cysts, they occur three times as often in women as in men.

Ganglion cysts are predominantly seen in young adults and are rare in children.

The cause of the ganglion cyst has been described as an outpouching of the lining of joints and tendons known in medical parlance as synovium.

This outpouching is brought about by an irritation of the joint surfaces creating a new formation or disintegration  of the supporting tissues of the synovium creating a space for fluid to accumulate, a process called cyst formation.

Although ganglion cysts can be uniform in swelling, they are most often made of different cyst within one swelling  (multilobulated ).

They can occur at any joint or tendon sheath, but they most often present on the back of the wrist at the wrist joint. They can also occur in  other parts of the hand with their names defined by their exact location.

Many patients who have had asymptomatic cysts for months or even years can present with newly developed pain or limitation of activity.

The skin above the cyst is usually unaffected and largely unchanged, but the mass itself is compressible and movable and transilluminates when a light is shown through it emphasising that it is a fluid filled swelling and not a solid tumour. 

The swelling can sometimes compress a major nerve or it's branches  and may elicit a tingling sensation.

Sometimes, it causes limitation of movement particularly when located at the undersurface of the hand. When this happens it means that it needs to be surgically removed.

 A cyst that is filled with mucus at the finger joint on the back of the hand, is frequently associated with osteoarthritis and may place pressure on or cause malformation of the nail.

Unlike the ganglia of the wrist as in your case, mucous cysts can cause the overlying skin to become thinned and may even lead to skin rupture.

Patients presenting with mucous cysts may complain of pain; however, the cause of the pain is often the associated osteoarthritis rather than the cyst itself.

Ganglion cysts can also occur within a bone, termed interosseous cysts. This type requires an open surgery for its removal.

Because the hand and wrist are very visible in day-to-day activity, and especially so since it is more common in females, aesthetics can be an indication for treatment.

Generally, though, pain, limitation of movement, and nerve palsies are indications for surgical excision. I am not sure if surgery is suggested   in your case because of any of  these. Your message was silent on these.

There are few contraindications for ganglion excision. Caution is advised, however, for those few patients who have only one upper extremity and desire elective removal of a cyst. This is so because any postoperative complication will create a substantially larger impact on such patients.

A plain x-ray usually provides visualization of the cyst and identifies bony abnormalities that may be causing the symptoms or may contraindicate treatment.

Magnetic resonance imaging, ultrasonography, or arthroscopic imaging may prove useful in obtaining confirmation of clinical diagnostic findings.

When the ganglion wall is thin, in the early stages, the cyst can be manually compressed until it bursts, and fluid is absorbed. 

A slightly more invasive approach, with a cure rate of about 85 per cent  results from a minimum of three aspirations of the fluid from the cyst with or without steroid injection into the cyst.

Another moderately invasive procedure is cyst puncture. In this treatment procedure, a suture is passed through the skin perpendicularly through the cyst and is left there for three weeks.  
     
Open surgery is the most invasive method employed when there are other worrying signs but then it leaves you with a scar.

By and large there is no risk of cancer so no need to fear however you need to see a surgeon, who will plan an acceptable treatment modality.

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