Are Ganglion Cysts Hereditary?

Ganglion cysts or synovial cyst is a benign outgrown mass that usually develops on the back of the wrist. About sixty to seventy percent of ganglion cysts are found on the back of the wrists. [2] In some individuals, the lump can be found in other parts of the hand such as the palm or below the cuticle of fingernails.  Thirteen to twenty percent (13 – 20%) of ganglion cysts are found on the palmar surface of the hand. Other body parts such as near the knee and ankle joints can also develop a ganglion cyst [3].

Ganglion cysts are three times more common in women than in men, and very rarely occur in children. Most patients who are diagnosed with cysts are between the ages of twenty and forty [1].

There are more than 200 heritable disorders of the connective tissue. These disorders stem from problems in the genes that code for the connective tissues. Although a ganglion cyst is not considered a heritable disease, it is not clear if a genetic predisposition of underlying connective tissues can contribute to the frequency of occurrence or likelihood of forming a cyst [1].

A ganglion cyst is not cancerous despite its outward appearance. It does not develop from any damage to the DNA of cells, rather, ganglion cysts are due to trauma to and degeneration of connective tissue. The degeneration of the connective tissue is accompanied by leakage and an accumulation of fluid within the tendon sheath. In some cases, pre-existing articular joint diseases, or mucoid degeneration of articular connective tissues can facilitate the development of ganglion cysts.

The cause of ganglion cyst is still unknown. However, different theories have been proposed to explain the etiology of the condition. One theory, capsular rent theory, suggests that the cyst develops from chronic or acute joint stress/trauma. This causes leakage and accumulation of synovial fluid around the joint. The reaction of the fluid with tissues of the joint results in the formation of the ganglion cyst.

A second theory holds that trauma to the joint can cause the breakdown of adjacent connective tissues and results in fluid accumulation and formation of a ganglion cyst. As fluid accumulates and the membrane swells, it pushes the skin outwards to give an unpleasant appearance of a lump. [4]

It is unclear where the fluid that makes up the cysts come from. Examination of the gelatinous fluid in the cyst shows that it is made up of hyaluronic acid and other proteinous molecules. The fluid appears to be thicker than and biochemically different from the synovial fluid that lubricates the joints.

Most patients who present in the clinic for ganglion cyst have different attitudes about their condition. Some patients reported pain and discomfort. Pain in dorsal ganglion could be due to compression of posterior interosseous nerve [4]. Other symptoms of ganglion cyst are reduced range of motion (ROM) in the wrist or joint, and decrease in grip strength due to weakened muscles. The lump is unsightly for the majority of patients. Ganglion cysts on the palmar surface can cause a tingling sensation from compression of the median nerve [4].

When a patient presented with ganglion cysts, a detailed medical and physical examination of the affected region of the hand is vital for a successful diagnosis. Most ganglion cysts are easily diagnosed with the naked eye or via an ultrasound imaging. However, some occult ganglion cysts are not always visible and require other diagnostic imaging. MRI and X-ray images of the wrists are adequate for locating hidden cysts, and for ruling out possibilities of cancerous lumps.

Non-Surgical

Some ganglion cysts disappear without treatment. Observation may be considered when a cyst is not causing symptoms. See the American Academy of Orthopaedic Surgeons guidance.

Needle aspiration is a nonsurgical option that removes fluid from a ganglion cyst. The cyst can return after aspiration because its connection to the joint or tendon sheath remains. See AAOS guidance.

Surgical

Surgical treatment involves removing the cyst and its stalk, sometimes with part of the adjacent capsule or tendon sheath [4]. A cyst can return after surgery. See AAOS guidance.

Following surgery, it is very important to continue to care for the hand/wrist to avoid or reduce postoperative complications and to facilitate a full recovery. Postoperative complications comprise infection at the surgical site, neuroma, lower range of motion, and decreased grip strength. Full recovery after surgery can take up to six to twelve weeks. Physical therapy and hand exercises can aid in full recovery.

Citations

1. Heritable Disorders of Connective Tissue (2019, July 8). Retrieved from NIAMS; that page is no longer published.
2. Chong, J. K. “The dorsal ganglion of the wrist, its pathogenesis, gross and microscopic anatomy, and surgical treatment.” Plastic and Reconstructive Surgery, vol. 59, no. 6, 1977, p. 876.
3. CLAY, N., and D. CLEMENT. “The treatment of dorsal wrist ganglia by radical excision.” The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, vol. 13, no. 2, 1988, pp. 187-191.
4. Gude, Warren, and Vincent Morelli. “Ganglion cysts of the wrist: pathophysiology, clinical picture, and management.” Current Reviews in Musculoskeletal Medicine, vol. 1, no. 3-4, 2008, pp. 205-211.

Ganglion Cyst Q&A Video with Dr. Knight