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How to Treat and Prevent Ganglion Cysts
Posted by Dr. Ben Kim
A ganglion cyst is a fluid-filled bump that forms under the skin near a joint, most commonly in the wrist area, and sometimes in the shoulder, elbow, hip, knee, ankle, or foot regions.
The conventional medical view of ganglion cysts is that they are idiopathic, meaning that definitive causes are not known. Ganglion cysts are usually left alone, aspirated, or excised.
My experience has been that ganglion cysts - especially those that occur in the wrist area - tend to arise due to underlying joint dysfunction.
All of your joint surfaces are cushioned by a layer of tissue called synovial lining, as well as by liquid called synovial fluid.
If the joints in your wrist region are not moving properly and/or under constant strain, the synovial lining in this area can get irritated to a point where it begins to get squeezed out from between your wrist bones, creating a pouch-like appearance below the surface of your skin. Synovial fluid follows an outpouching as it develops, leading to a fluid-filled bump.
Many years ago, ganglion cysts were also called Bible bumps because the standard treatment for such bumps involved having one's doctor slam down on it with a heavy book, usually a Bible.
Smashing a ganglion cyst may cause it to break apart or shrink, but without addressing the root cause of a cyst, it will usually return over time; this is also true of cysts that are removed via aspiration or excision, though the recurrence rate for cysts that are properly excised is lower than that for those that are simply aspirated.
If you have a bump around one of your joints that resembles a ganglion cyst, the first step to take is to visit your physician to confirm that your bump is indeed a ganglion cyst. Sometimes, other conditions like lipomas, bone spurs, local infections, and in rare cases, even bone tumors, can present like ganglion cysts.
Once you and your physician are sure that you have a ganglion cyst, the next step to take is to think about ways in which the affected joint is being strained on a regular basis. If you can identify an everyday activity that could be irritating the affected area, look for a way to reduce or modify that activity. In the case of a ganglion cyst in the foot or ankle region, the cause might be poor choice in footwear (See: Shoes and Sandals for Healthy Feet).
If appropriate rest and/or addressing the aggravating activity doesn't lead to significant improvement, you may want to visit a chiropractor, physiotherapist, osteopath, naturopath, or other health care practitioner who has experience mobilizing joints.
Joint mobilization involves putting the bones that make up your joints through basic ranges of motion to help ensure smooth and full joint motion, which is critical to addressing and preventing ganglion cysts since restricted joints can be a primary cause of ganglion cyst formation.
For example, in your wrist region, you have eight small carpal bones that are neatly arranged in two rows. Each of these carpal bones should have a certain amount of give, called joint play. An experienced practitioner can put each of your carpal bones (and the bones that lie below and above your carpal bones) through various ranges of motion to help ensure that the synovial linings in this region aren't being irritated by your everyday activities.
A good practitioner can also provide guidance on how to do specific stretches and exercises with the affected area to help promote optimal joint motion and reduce the likelihood of having a ganglion cyst come back.
Sometimes, a ganglion cyst arises from a tendon sheath, though this scenario is less common than cysts that arise from within joints. In the case of a cyst that comes from a tendon sheath, it's still wise to follow the steps above i.e. visit your physician to confirm the diagnosis, and try to identify everyday activities that may be aggravating the tendon/muscle involved.
If the cause of a tendon sheath-derived ganglion cyst is a short, scarred, or injured tendon/muscle, I recommend seeking an evaluation and treatment from a practitioner who is familiar with Active Release Technique, also called ART.
ART involves applying manual pressure on tendons, muscles, and other soft tissues while the target tissues are put through their normal ranges of motion. Applying pressure to tissues while they are in motion can help promote optimal range of motion of the target area, as well as healthy soft tissues in the area through increased blood flow.
To find a certified ART practitioner in your area, you can do a search here:
Please note: I know a number of chiropractors who are highly skilled with ART but not certified by the organization that provides formal ART training. To me, certification isn't as important as how often the practitioner uses ART in his or her practice. In looking for someone who can provide ART, simply ask how experienced the practitioner is with it.
The bottom line on ganglion cysts is this: They're benign, and only present a problem if they restrict range of motion or cause discomfort during everyday activities. For some people, ganglion cysts create psychological and emotional burden, as they look unusual.
If there is significant joint restriction or discomfort, the best first step is to have an experienced practitioner ensure optimal health of the joints and soft tissues involved; if this doesn't lead to significant improvement, it's best to have an experienced surgeon excise the ganglion cyst, and then to continue with alternative treatments to ensure that the joints and soft tissues involved return to optimal health, which will reduce the likelihood of having the cyst return.
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