Ganglion cyst: a comprehensive review with homeopathic therapeutic approaches

Dr Priyanka Jadav

ABSTRACT:
The natural history of ganglion cysts (of which 50% will resolve on their own), diagnosis, and treatment of this prevalent condition are reviewed in this article. According to the majority of current theories, extra-articular mucin “droplets” consolidate to create the tumor’s main body, even if the exact mechanism of cyst formation is unknown. The formation of the “cyst wall” and pedicle, which connect the cyst to a nearby synovial joint, occurs later. The most common soft tissue mass is seen in the hand and wrist, but it can also be found in the knee and foot. Although the majority of ganglion cysts are asymptomatic, patients may present with pain, tenderness, and weakness. Treatment options include surgical removal, nonoperative aspiration/injection, and observant waiting. A significant rate of recurrence is associated with cyst aspiration/injection. This article mainly deals with an overview of ganglion cysts, focusing upon their various aspects along with Homeopathic therapeutics.

KEYWORDS: Cyst ,ganglion , Homeopathy , Homeopathic therapeutics.

INTRODUCTION:
Ganglion cyst is a small fluid-filled sac that forms a visible lump ,often occurring on the top or bottom of wrist ,fingers, over a joint or tendon. It is also called a Bible cyst/ bump. Cyst contains thick ,sticky,clear,colorless and jelly- like material.

Typically anchored in place , but when pressed can be moved very slightly. A cyst can change size and shape over time . Benign in nature and cannot spread to other parts of the body.

EPIDEMIOLOGY:
Ganglion cysts account for 60% to 70% of soft-tissue masses observed in the hands and wrists. Although they can develop at any age, they are most typically encountered in women between 20 and 50 years. Women are three times as likely as men to have ganglion cysts. These cysts are also common in gymnasts, most likely due to recurrent trauma and tension on the wrist joint.

RISK FACTOR :

• Injury to the wrist or finger.
• Inflammation in a joint or tendon.
• Repetitive wrist or finger activities.
• Chronic conditions like arthritis.
• Gender : Females (20-50 years).

PATHOPHYSIOLOGY :
Ganglion cysts are benign soft tissue tumors most commonly encountered in the wrist on the dorsal aspect and communicate with the underlying joint via a pedicle. Approximately 20% of ganglion cysts are seen on the volar aspect of the wrist, originating from the radiocarpal or scaphotrapezial joints. The remaining 10% of ganglion cysts can develop from multiple areas of the body, including the volar retinaculum of the wrist, distal interphalangeal joint, ankle joint, and foot. Wrist volar retinacular cysts form when fluid protrudes from the herniated tendon sheath.Ganglion cysts arising from the dorsal distal interphalangeal joint are called mucous cysts and are associated with Heberden nodules.

• Analysis of cystic fluid reveals that it is a gelatinous material containing mainly hyaluronic acid and lesser amounts of glucosamine, globulins and albumen. This fluid is different biochemically and is much thicker than intra-articular synovial fluid. The origin of the fluid has not been fully elucidated, but it has been postulated to arise from one of three mechanisms.
• Firstly, it may originate from within the joint, outpouching into the cyst by motion of the wrist.
• Secondly, from an extra-articular degenerative process resulting in cyst formation and subsequent communication to the joint.
• Finally, it may originate from mesenchymal cells within the cell wall.
• It is possible that a combination of these mechanisms contributes to the ganglion cyst.

CLINICAL FEATURES:

• Common in females.
• Size shows variation with time.
• Intermittently painful, usually following acute or repetitive trauma.
• Up to 35% are without symptoms except for appearance.
• Pain:

– Chronic

– Made worse by joint motion.

• If the cyst is connected to a tendon, weakness in the affected finger.

Signs and symptoms:

• Swelling that may appear over time or suddenly.
• A soft bump or mass that changes size but doesn’t move.
• Weakness when it is connected to a tendon.
• Pain if the cyst presses on a nerve.
• Numbness if it presses on a nerve.
• Limited range of motion.

On examination:

INSPECTION

• Swelling on dorsum of wrist
• Pea size (occasionally larger)

PALPATION

• Very firm/bony hard

DIFFERNTIAL DIAGNOSIS

1. Tenosynovitis
2. Lipoma
3. Sarcoma
4. Giant cell tumor of tendon sheath
5. Osteoarthritis

TENOSYNOVITIS: Inflammation of the tendon sheath, often due to repetitive movements, overuse, or infection. No visible lump, but the affected area may be swollen or tender. Pain, tenderness, and difficulty moving the affected tendon. In some cases, a snapping or locking sensation.

LIPOMA: A benign tumor made of fat cells. Soft, doughy, and movable under the skin. Can develop anywhere on the body, but commonly on the neck, shoulders, arms, or back. Usually painless, slow-growing, and not attached to underlying structures.

SARCOMA: A malignant (cancerous) tumor arising from connective tissues such as bone, muscle, fat, or cartilage. Can feel firm or rubbery, may be deep-seated and attached to underlying structure. Can develop anywhere in the body, including the limbs, abdomen, or soft tissues. Usually painless at first, but can grow, cause pain, or press on nerves and organs. May show rapid growth.

GIANT CELL TUMOR OF TENDON SHEATH: A benign but locally aggressive tumor that arises from the tendon sheath due to abnormal proliferation of synovial cells. Firm, rubbery, and usually not movable. Commonly found on the fingers, hand, or wrist, near a tendon. Slow-growing lump, Can be painful, especially if pressing on nerves. May cause stiffness or restricted movement.

OSTEOARTHRITIS: Degeneration of joint cartilage due to aging, wear and tear, or injury. Joint pain and stiffness, especially with movement. Swelling and reduced range of motion. Bony growths (osteophytes) may develop. Common in weight-bearing joints (knees, hips) and hands.

DIAGNOSIS:

• Most ganglion cysts are diagnosed clinically.
• A plain x-ray film rules out osteoarthritis or bone malignancies.
• Ultrasound and Magnetic Resonance Imaging: To asses the shape, size and depth of the cyst.
• Aspiration for microscopy.
• Computed Tomography scan to rule out malignancies.

MANAGEMENT:

CONSERVATIVE:

• If the cyst does not cause any pain, the usual recommended treatment is to simply monitor, as cysts often disappear spontaneously without further intervention.
• If the cyst causes pain or severely limits range of motion, there are two main interventions that can be performed.

ASPIRATION: With this procedure, a needle is placed into the cyst to draw the liquid material out. The steroid compound (anti-inflammatory) is injected into the area and the area is put in a splint to keep it from moving. Aspiration doesn’t remove the area that attaches the cyst to the joint, so they often return.

SURGICAL INVASION:
With this procedure, the cyst and the area around it that attaches it to the joint are excised.

HOMOEOPATHIC THERAPEUTICS:
Homoeopathy is based on the principle of “like cures like.” This means that a substance causes symptoms in a healthy person can, in a much-diluted form, help treat similar symptoms in a sick person. Homeopathic treatment of the Ganglion cyst. Most of the ganglion cyst, with moderate or severe symptoms, will respond to the administration of the Homeopathic medicines.

The list of Homeopathic Medicine for ganglion cyst are given below:

1. Calcarea carb: Hard, slow-growing, round, and firm ganglion cyst. Tends to form over joints, especially wrists and hands. Usually painless, but may become tender with pressure or overuse. Worse from cold and damp weather. Better by warmth and covering the area.
2. Phosphorus: The ganglion may feel soft and fluid-filled rather than hard. The cyst may grow quickly and might reappear after drainage or resolution. Worse from touch and pressure. Better with cold applications.
3. Calcarea flour: The ganglion feels firm, almost like a bony growth, rather than soft or fluctuant. The cyst tends to form gradually over time. The ganglion may not cause much pain unless pressed or irritated. Symptoms may aggravate in cold or damp conditions. Better with warm applications.
4. Phosphoric Acid: If the ganglion develops after stress, weakness, or chronic fatigue. Generally more suited for individuals with mental exhaustion or emotional strain. Painless or mildly tender cyst. Associated with nerve exhaustion.
5. Benzoic acid: Suitable for firm, indurated (hardened) ganglion cysts, especially if they develop slowly over time. A peculiar characteristic is strong-smelling urine, often compared to the odor of horse urine. Useful when ganglion cysts form along tendon sheaths and are associated with stiffness or aching. Symptoms of cysts aggravate in humid conditions.
6. Ruta: cysts that develop in areas subject to repetitive strain, such as the wrist, hand, or ankle. The ganglion may feel firm or knot-like, often restricting movement of the affected joint. There may be dull, aching pain, especially when using the affected limb. Symptoms worsen with continued strain, lifting, or repetitive movements and better from rest and warmth. Commonly used for sprains, strains, and chronic injuries affecting the soft tissues, which can contribute to ganglion formation.
7. Plumbum Met : Hard, firm, and deep-seated, rigid ganglion and resistant to pressure. Slow-growing and chronic in nature. There may be numbness, weakness, or a sensation of tightness in the affected limb. Pain may feel like it is radiating along the nerve.
8. Ammonium carb: Ganglions that feel firm or tense, possibly with a dull aching sensation. Worse in cold or damp weather. People with sluggish circulation, which might relate to the formation of cyst. Ganglion is tender or painful when pressed.
9. Silicea: Hard, firm, and persistent cysts that develop gradually over time. Associated with weakness or sweaty palms and feet. The cyst may be tender or painful when pressed. Symptoms aggravate in cold, wet conditions and are better with warmth.

10.Carbo veg: Suitable for persons who tend to have cold hands and feet, slow healing, and general sluggish tissue repair. The cyst is firm, non-tender, and persistent, without significant pain or inflammation. Symptom are worse from cold and damp weather and better from warmth and raising the limb.

RUBRICS RELATED TO GANGLION CYST

Synthesis repertory

• FACE – SWELLING – Ganglions
• FACE – SWELLING – Ganglions – Chin; under the CHEST – HYPERTROPHY – Mediastinal ganglion
• EXTREMITIES – GANGLION
• EXTREMITIES – GANGLION – Feet
• EXTREMITIES – GANGLION – Feet – Back of feet
• EXTREMITIES – GANGLION – Feet – Soles
• EXTREMITIES – GANGLION – Feet – Soles – right
• EXTREMITIES – GANGLION – Hands
• EXTREMITIES – GANGLION – Hands – right
• EXTREMITIES – GANGLION – Hands – Back of hands
• EXTREMITIES – GANGLION – Hands – Palms
• EXTREMITIES – GANGLION – Instep, on the
• EXTREMITIES – GANGLION – Upper limbs
• EXTREMITIES – GANGLION – Wrist, on
• GENERALS – TUBERCULOSIS – Ganglion
• GENERALS – TUMORS – ganglion

Complete repertory

• GANGLION:
• GANGLION; tendons
• GANGLION; upper limbs
• GANGLION; upper limbs; left
• GANGLION; elbows
• GANGLION; elbows; left
• GANGLION; wrists
• GANGLION; wrists; back
• GANGLION; hands
• GANGLION; hands; back of
• GANGLION; hands; palms
• GANGLION; finger, first, thumb, left
• GANGLION; calf, below right
• GANGLION; feet
• GANGLION; feet; back
• GANGLION; feet; soles
• GANGLION; feet; soles; right
• GANGLION; painful
• GANGLION; painful; upper limb, left
• GANGLION; painful; upper limb, left; elbow
• GANGLION; painful; calf, below right
• GANGLION; painful; feet, soles, walking agg.

CONCLUSION:
The interest in ganglia and the wide range of treatments that have been developed are most likely due to its frequent presentation to physicians and the lack of a completely suitable form of therapy. The physician can provide guidance as the patient selects the most appropriate course of action for their circumstances by using a comprehensive understanding of the natural history of ganglia as well as the available treatment options and results. This article focuses on many homoeopathic remedies that are beneficial in the treatment of ganglion cysts, as well as rubrics associated with the condition’s symptoms. These, however, are merely suggestions for selecting the simillimum.

REFERENCES:

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Dr. Priyanka Jadav
PG Scholar, Department of Practice of Medicine.
Government Homoeopathic Medical College and Hospital. Bengaluru – 560079
Under Guidance of:  Dr. Praveen Kumar P. D Professor and Head of department
Email : priyankajadav661@gmail.com