May 18, 2022

Interviewer: So if you've been on social media lately and follow any of those pimple popper videos or whatever, you may have heard of a ganglion cyst. It is a small bump that usually shows up on the hands or the joints. And online, they'll tell you to pierce it with a needle or hit it with a big old book. We're going to find out if that's the right way to treat these big old cysts.

Joining us today is Dr. Brad Rockwell. He is a professor of plastic surgery and he works with hands.

Now, Dr. Rockwell, when it comes to a ganglion cyst, what is it?

Dr. Rockwell: All of our joints have fluid inside that's somewhat similar to oil to keep the bones moving freely. And around the joint, there's a skin layer that keeps the fluid inside the joint. If that skin layer gets a little weak spot, it can form a bubble and the normal fluid that's in the joint can enter that bubble. It stretches out that skin lining and then the bubble can get bigger and bigger. And eventually, that bubble can work its way up to be visible beneath the skin. And that's a ganglion.

Interviewer: So it's not just when you see pimple popper videos or whatever online it's oil or it's trapped dermatological fluid. This is something that your joints need to function correctly.

Dr. Rockwell: Yes. It's just normal structures that have moved outside of the joint and usually form under the skin. But they still have an attachment to the joint.

Interviewer: Oh, wow. Okay. And do they only show up on the hands, or can they show up in any joint?

Dr. Rockwell: They can show up in any joint. There are some that are more common. Palm side of the wrist, the back of the wrist, or the end joint in the finger are common spots. But the back of the knee is another common spot where orthopedists would treat ganglions.

Interviewer: Now, is there anything in particular that causes them? Any cofactors or anything, or are some people just more predisposed to having these, some activities that they do?

Dr. Rockwell: Most of the joints, we don't know. They may, to some degree, be arthritis-related, but most of the ones in the hand at the wrist don't have a specific arthritic etiology. At the end joint on the finger, there's a definite arthritic etiology. There's, in general, a bone spur that's there. The bone spur rubs on that skin inside joint layer and weakens it and allows the bubble to form, which becomes the ganglion.

Interviewer: Now, is there a way to, say, identify that it is a kind of ganglion cyst or it's one of these joint fluids, not something else that you should probably not be popping anyway?

Dr. Rockwell: Most times a doctor could look and tell. In general, where a ganglion is there is not something else comparable that would be in the same spot.

For a patient, they may notice that it increases and decreases in size. It is normal joint fluid that's beneath a stretched-out joint lining skin layer. Occasionally, that lining that contains the fluid can weaken and develop a little hole and the fluid may escape from the ganglion, and then the fullness will go away. The fluid escapes under the skin and gets resorbed. There are no symptoms associated with that.

So if someone notices a mass over the joint that gets bigger and then gets smaller and gets bigger, that's going to be a ganglion.

Interviewer: All right. So we now know what these things are, where they come from. Now, I've seen some pretty gnarly videos on the internet. Why or why not should someone pop them or hit them with a book?

Dr. Rockwell: Well, deflating a ganglion in the end is a good treatment. There's a medically appropriate way to do it. Popping it at home or hitting it with a book to try to rupture that skin layer may accomplish the same endpoint, but the body won't necessarily see it as a friendly way to treat the ganglion.

So, in the office, rather than popping it, we will put a little needle into it and drain the fluid. So put some lidocaine in the skin to numb the skin, clean the skin well, and then put a needle in and drain the fluid out. And about 20% of the time, that will be successful in treating the ganglion.

Eighty percent of the time, unfortunately, the fluid will recur. And then it can be drained again, although most likely if it recurred once, it will recur again. If it recurs once, surgery is the best option to resect the ganglion down to the level of the joint.

Interviewer: What are some of the potential dangers of, say, doing it at home by yourself? It's not just a big pimple on the back. This is something that's connected to your joints.

Dr. Rockwell: Yes, exactly. It's a fluid-filled cavity that has a connection to the joint. So if it's popped at home and an infection develops in the ganglion, the infection has a very short direct route into the joint. And an infected joint would be a horrible outcome from ganglion treatment.

Interviewer: Geez. So say someone finds themselves with a ganglion cyst. They now know, "Hey, don't treat it at home." What kind of doctor should they be going to? Is this something that you go to a primary care physician, an InstaCare, a dermatologist?

Dr. Rockwell: So if it's in the hand, it should be a hand surgeon, and hand surgeons are either orthopedic-trained or plastic surgery-trained. If they're in other joints, most likely it would be an orthopedist.

Most of the other bigger joints in our body, the ganglion would be deeper under the skin or the patient may not actually know there is a ganglion there. But if they have arthritic trouble and are seeing a rheumatologist or an orthopedic surgeon for the arthritis, the doctor would recognize that the ganglion is there and then suggest appropriate treatment.

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