Fingers: Ganglion Cysts

So, I've noticed a few posts on certain climbing websites discussing ganglion cysts within the fingers, and so decided that I would write a post about them, considering there were one problem I omitted from the original finger injuries post.

What is a ganglion cyst?

A ganglion cyst is a liquid filled area within a joint capsule or tendon sheath that has bulged out to a particular side.
These cysts are caused by a congenitally weaker part of the capsule or sheath that cannot handle the extra pressure of over-creation of synovial fluid, which is created by over use and chronic stressing of joints. 
They can vary in size from pea to golf ball sized, and can occur anywhere in the body but most commonly in wrists and fingers. The size is often related to the amount of stress placed on the joint, therefore more stress = larger cyst, and this is why they most commonly occur in flexor tendon sheaths of climbers, just before the first finger joint.
Ganglions are normally harmless but can cause pain, especially if they irritate a nerve. 


Symptoms

• Pain
• Visible swelling of a lump
• Decrease in mobility around the joint

Treatment

The old adage of "smack it with a book" doesn't really work for cysts, no matter how much someone encourages you! As, even if it works and gets rid of the cyst for a little while, it will only refill.

Common treatments involve aspiration, steroid injection, or surgical removal of the cyst, however, some have suggested ultrasound as a treatment for the pain caused by the cyst.

Some people have steroid injections into/around the cyst to relieve the pain, however it is worth noting that steroids have been known to weaken tendons and tissues and so could cause further problems with the cyst. 
Varley et al (1997) found that there was equal success rate of removing a ganglion cyst (33%) with aspiration (insertion of a needle and draining the fluid, as depicted above) compared with aspiration and injection of steroid.

The other option is to have the cyst surgically removed, which has a re-occurrence rate of the cyst of only about 5%.

Prevention

Unfortunately, there is no current way of preventing a ganglion cyst, however they could be caused by unnecessary stresses on your joints, so avoiding or adapting the effect of these stresses could help, for instance, adapting / changing your climbing style, climbing more efficiently.

Ensuring full range of movements within your joints will also reduce the stresses put on the joint.
 
As usual, ensuring proper warm up/cool downs and eating well will aid the prevention of injuries.


References

Hochholzer T, Schoffl VR 2006 One Move Too Many. Lochner-Verlag, Germany

NHS Choices

Varley GW,  Needoff M, Davis TRC, Clay NR 1997 Conservative management of wrist ganglia: Aspiration versus steroid infiltration. Journal of Hand Surgery 22(5): 636-637