Ganglion Cysts and Physiotherapy

A ganglion cyst is a non-cancerous, fluid-filled lump that typically forms near a joint or a tendon, most commonly in the wrist or hand, but they can also occur in other areas of the body like knee and ankle. Ganglion cysts are round or oval in shape. They can vary in size from small pea-sized lumps to larger size masses.

 

Causes Of Ganglion Cyst

• repetitive stress to a joint or tendon causing micro-trauma
• overuse injuries such as typing, playing musical instruments, or sports related
• direct trauma such as a blow to the hand or wrist
• disorders like osteoarthritis, rheumatoid arthritis, or tendinitis increase the risk
• more common in women than in men between the ages of 15 and 40
• can be a result of genetic predisposition

 

Symptoms of Ganglion Cyst

Ganglion cysts often do not cause symptoms, and they may be discovered incidentally during a physical examination causing other musculoskeletal disorders like foot drop, cubital tunnel syndrome etc. However, when symptoms do occur, they can include:

• noticeable round or oval shaped lump under the skin
• applying pressure elicit pain varying in its intensity
• joint movements are hindered mainly due to stiffness
• feeling of discomfort usually occurs if cyst is present near joint
• tingling or numbness in the affected area if nerve is involved
• skin appears swollen and red on affected area

 

Does Ganglion Cyst occurs due to Vitamin Deficiency?

A ganglion cyst is not caused by vitamin deficiency. While there is no direct link between ganglion cysts and vitamin deficiencies, maintaining overall good health and proper nutrition can be important for your body's ability to heal and manage various conditions.

 

Diagnosing Ganglion Cyst

• MRI - help understand  location, size, and extent of cyst
• Electroneuromyography (EMG) – assessing  nerve compression
• Ultrasound
• ENG

 

Differential Diagnosis

• Synovial Cyst
• Lipoma
• Rheumatoid Nodule
• Abscess
• Tendon Sheath Tumor
• Hemangioma
• Bursitis
• Tenosynovitis
• Enlarged Lymph Node
• Gout – deposition of  uric acid in form of tophi

 

Ganglion Cyst on Wrist

Ganglion cysts are commonly found in the hand and wrist. They are more common in women between the ages of 15 and 40. Imaging studies like ultrasound and MRI  are used to confirm the diagnosis.

Treatment Options:

• aspiration (draining the cyst) but it has higher chances of recurrence
• surgical excision have recurrence rate around 20%
• arthroscopic or minimally invasive techniques

Complications:

• infection,
• nerve or blood vessel injury
• scarring

Ganglion Cyst on Finger

Ganglion cysts are common in the hand and wrist, and they are frequently found on the fingers. They are more prevalent in women, and the age of onset varies but is often seen in young adults.

Location:

• metacarpophalangeal (knuckle) joints 
• proximal interphalangeal (PIP) joints
• distal interphalangeal (DIP) joints

Conservative Management:

• rest
• splinting
• changes in activities

Ganglion Cyst on Foot

Ganglion cysts can occur in various locations within the foot, with the most common site being the dorsal (top) aspect of the foot. The occurrence is relatively rare tough. Ultrasound or MRI are used for diagnosis. It also causes pain and functional impairment  if they are located in weight-bearing areas.

Treatment Options:

Treatment options for ganglion cysts in the foot are similar to those for other areas of the body as mentioned above. Surgical excision is often recommended when the cyst causes significant pain and  impairs foot function.

Nonsurgical management:

• rest,
• orthotic devices
• changes in footwear

 

Ganglion Cyst on Knee

Ganglion cysts in the knee are relatively rare compared to other locations, such as the hand and wrist. These cysts can occur within or around the knee joint, often in proximity to ligaments or tendons.  Sometimes it causes acute foot drop due tp intraneural ganglion cyst that forms over the peroneal nerve.

Symptoms:

• swelling
• limited range of motion

Differential Diagnosis:

• meniscal tears
• Baker's cysts
• synovial cysts

 

Other Locations Include

Elbow:

• Elbow ganglion cysts are typically found on the dorsal side of the joint, near the olecranon process, which is the bony prominence at the back of the elbow. It may lead to Cubital tunnel Syndrome.

Shoulder:

• These cysts can form around the shoulder joint, particularly near the acromioclavicular joint or the rotator cuff tendons affecting suprascapular nerve.

Ankle:

• Ankle ganglion cysts are less common but can develop around the Achilles tendon or within the ankle joint itself.

Hip:

Although rare, ganglion cysts can occur in the hip region, typically near the hip joint or in proximity to hip tendons.

Spine:

Ganglion cysts can even occur in the spine, particularly in the lumbar (lower back) region usually in the mobile segments. Spinal ganglion cysts presents with radiculopathy.

Temporomandibular Joint (TMJ):

Infrequently, ganglion cysts may appear in the temporomandibular joint, which connects the jaw to the skull. 

Physiotherapy Treatment Of Ganglion Cyst

Range of Motion (ROM) Exercises:

Physiotherapists may prescribe gentle exercises to help restore and maintain the normal range of motion in the affected joint. These exercises can prevent joint stiffness and muscle weakening that may occur after cyst treatment.

• Wrist Flexion and Extension (for wrist ganglion cysts)
• Wrist Pronation and Supination (for wrist ganglion cysts)

 

Strengthening Exercises:

Strengthening exercises for the muscles surrounding the affected joint can help provide stability and support. This is especially important after the surgical removal of the cyst.

• Thumb Opposition - Pinch a small object (e.g., a coin) between your thumb and each finger one at a time.
• Finger Flexion/Extension - Place a soft rubber ball or therapy putty in your hand and squeeze the ball or putty, then release to extend your fingers.
• Wrist Extension- Hold a lightweight object (dumbbell or thera band) with your palm facing down. Extend your wrist upward against resistance.
• Wrist Flexion - Flex your wrist downward against resistance.
• Wrist Pronation and supination against resistance 
• Grip strengthening

 

Electrotherapy:

Ultrasound Therapy:

1. Increased blood flow and tissue circulation, which can aid in reducing inflammation.
2. Enhanced tissue healing and collagen production.
3. Increased tissue temperature, which may help relieve pain and discomfort.

Laser Therapy or Cold Laser Therapy:

• Stimulation of cellular energy production, which may promote tissue repair and reduce pain.
• Reduction in inflammation and edema.
• Improved circulation in the affected area.

 

Transcutaneous Electrical Nerve Stimulation (TENS):

1. Pain relief by stimulating the release of endorphins and interfering with pain signal transmission.
2. Muscle relaxation, which can help alleviate muscle tension and spasm associated with the cyst.

 

Interferential Current (IFC):

1. Pain reduction through the interference of pain signals.
2. Increased circulation and improved lymphatic drainage, aiding in swelling reduction.

 

Pulsed Electromagnetic Field (PEMF) Therapy:

1. Stimulation of cellular repair and regeneration.
2. Reduction of pain and inflammation.
3. Enhanced circulation and oxygen delivery to the affected area.

  

Iontophoresis:

1. Enhanced transdermal drug delivery, allowing for the application of medications (e.g., corticosteroids) through the skin to reduce inflammation and pain.

 

Functional Rehabilitation:

For those with recurrent or persistent cysts, physiotherapists may work on functional rehabilitation programs to address specific issues and improve the overall functionality of the affected joint.

 

Post-Operative Management

• Apply mild pressure through application of dressing for 48 h to avoid swelling
• Guide Active Range of Motion exercises to patient  depending on the location of cyst and joint involved
• pendular exercises for shoulder involvement
• strengthening program
• Orthotic Devices - such as braces or splints, to support and protect the joint during the healing process

 

Prevention Strategies 

• avoid repetitive trauma
• wear protective equipment such as wrist guards, knee pads, or appropriate footwear to minimize the risk of injury
• warm-up and stretch prior to activity
• maintaining a healthy weight and consuming a balanced diet
• early treatment prevents the progression of joint-related issues
• proper technique should be used while performing any activity
• ergonomics should be taken into consideration