Synovial cysts and basic knowledge to know

Synovial cysts most commonly occur in women. Age ranges from 20-40 years old, accounting for 70%. Very rarely, synovial cysts occur in children under 10 years of age. The disease is common and usually harmless, does not progress to cancer, and resolves on its own without treatment. Synovial cysts can cause pain or interfere with joint movement. When symptoms are present, the doctor may drain the fluid with a needle, or surgically remove the cyst. If there are no symptoms, no treatment is necessary as they may go away on their own.

content

• 1. The concept of translation ability
• 2. What causes synovial cysts?
• 3. Risk factors for synovitis
• 4. Some Symptoms
• 5. How to diagnose synovial cyst?
• 6. Methods to treat synovial cysts
• 7. Synovial cyst complications
• 8. Prevention of synovial cysts

1. The concept of translation ability

A ganglion cyst is a small sac filled with viscous, thick, colorless or pale yellow, jelly-like fluid. This fluid reservoir is round or oval in shape, varying in size from as small as a pea and can be as large as 2.5 cm. They are formed along tendon fibers or at joints. Synovial cysts occur most commonly on the dorsal surface of the wrist joint, but can also occur on the palmar surface of the wrist. Other less common locations such as: the soles of the bases of the fingers, the tips of the fingers, the outer surface of the knee and ankle joints, the instep...

2. What causes synovial cysts?

The exact cause of synovial cysts is still unknown. It is theorized that injury or overuse causes joint tissue destruction. From there, small pockets of fluid form, which then coalesce into a larger, clearer mass. Most theories involve an opening in the joint capsule or tendon sheath that causes the joint tissue to bulge.

Synovial cysts usually occur on the back of the wrist.

3. Risk factors for synovitis

Factors that increase the risk of synovial cysts include:

• Gender, age: Synovial cysts can occur in anyone. However, they usually occur in females and between the ages of 20 and 40.
• Osteoarthritis: People with osteoarthritis of the distal interphalangeal joint are at increased risk of developing synovial cysts in those joints.
• Tendon and joint damage: Tendons and joints that have been damaged in the past are more likely to develop synovial cysts.

See more articles: What are the symptoms of knee pain?

4. Some Symptoms

Swelling:

• Synovial cysts cause swelling and tumors in the joints, especially the wrist and hand joints. It is usually soft, varies in size from 1 to 3 cm, and is not mobile. Swelling can come on slowly, increase over time, with a lot of movement, or it can come on suddenly. Otherwise, they may shrink, or even disappear, without treatment.

Pain:

• Synovial cysts are usually painless, with up to 35% being asymptomatic. However, they can cause varying degrees of pain, often following acute or repetitive trauma. When present, they often cause chronic pain, and pain increases with joint movement. When synovial cysts appear in the tendon sheath, they can weaken the motion that tendon governs. If they appear on the feet, the ankles can be uncomfortable when walking and wearing shoes.

Wrist pain due to synovial cyst.

Other neurological symptoms:

If they appear near nerves, sometimes symptoms such as loss of mobility, tingling sensations, etc.

5. How to diagnose synovial cyst?

When a tender or painful lump appears in the wrist, hand, ankle or foot, an orthopedic or musculoskeletal specialist should be seen for examination and treatment if necessary. To make a diagnosis, your doctor will ask how long the tumor was present and when symptoms occurred. At the same time, the doctor will examine and evaluate the tumor for its location, size, and nature. To confirm the diagnosis of a synovial cyst with certainty, additional tests such as:

• Use a needle to withdraw fluid from the cyst, test, and observe. The fluid of the synovial cyst is usually pale yellow, viscous, and viscous. In addition to diagnosis, they also help treat synovial cysts.
• Ultrasound : helps to determine whether the tumor inside is solid or fluid.

Ultrasound diagnosis of carpal synovial cyst.

• X-ray : although it can't see cysts, it helps to rule out cases of osteoarthritis, bone tumors...
• MRI : Helps to show well tumors and soft tissues. Helps to distinguish the characteristics of tumors in the most clear way.

6. Methods to treat synovial cysts

Synovial cysts usually cause no symptoms and do not require treatment. Your doctor may recommend monitoring and doing the following:

• Immobilization: Movement of joints with synovial cysts often increases their size and increases pressure on the nerve causing pain. Avoid repetitive wrist or hand movements. Wearing a wrist brace can help shrink the synovial cyst. In addition, splints also help relieve pain when symptoms are present. When the pain is gone, you can do exercises that help strengthen your wrist and range of motion.
• Wear shoes that do not touch the synovial cysts, if they appear on the ankle or foot.

If they cause pain and interfere with joint range of motion, treatment will be needed. There are 2 treatment methods: aspiration and surgical removal of the cyst.

6.1 Suction

Cyst suction method.

Performed by using cum injection to puncture the cyst and drain the fluid out. Then inject anti-inflammatory corticosteroids to limit the re-establishment of cystic fluid. Wear an immobile wrist brace, which can be removed 6 hours after the procedure. If the wrist fluid is removed 3 separate times, the cure rate is 30-50%. Treatment success rate is high for synovial cysts in the carpal flexor tendon sheath. This is a very simple procedure, does not cause pain, can be discharged immediately after. However, about half of cases come back after aspiration.

6.2 Cystectomy

If the above treatments are unsuccessful, surgical removal of the cyst is necessary. There are 2 types of surgery that can be used to remove a synovial cyst:

• Open surgery: The surgeon makes an average skin incision about 5 cm at the site of the affected joint or tendon.

• Arthroscopic surgery: Smaller incisions are made to insert the endoscope and instruments into the joint. The doctor will use an endoscope to guide and insert instruments to remove the cyst.

Cystectomy surgery.

Both types of surgery are equally effective at removing and preventing the cyst from returning. Laparoscopic surgery tends to be less painful after surgery, however the waiting time is longer. After surgery, wear a splint to immobilize the joint for up to 7-10 days. Move your fingers often to keep joints flexible. Recent studies show that splinting over a long period of time doesn't really help. The use of joints immediately after treatment is recommended.

Synovial cysts can still recur after performing aspiration and surgical resection. However, surgery showed a lower recurrence rate than cyst aspiration.

7. Synovial cyst complications

Surgery to remove the tumor is a small, simple procedure, so complications are rare. However, a small number of people experience permanent stiffness and pain after surgery. With general anesthesia, there is also a small risk of complications to the heart and lungs.

The risk of infection if not treated properly is very high. Also, synovial cysts can always come back after treatment. This is more likely to happen if it is located in the wrist area. 

8. Prevention of synovial cysts

Limit excessive, repetitive, or wrist movement.

Do not arbitrarily treat at home with wrong methods such as self-puncturing the cyst, squeezing the fluid. This makes it very easy to get infected, and aggravate the condition.

See also:  Exercise with musculoskeletal patients .

Synovial cyst is a fairly common disease. Although not a malignancy, it can cause discomfort when moving joints, especially wrist joints. The above article provides information to help us prevent the disease as well as recognize the symptoms of the disease earlier. When there are any symptoms of the disease, it is necessary to consult a specialist for timely examination and treatment. It is necessary to avoid cases of self-treating at home in the wrong way such as self-puncture of the cyst.

Doctor Nguyen Huynh Thanh Thien