Ganglion Cysts: Symptoms, Diagnosis, and Treatment Options

Ganglion cyst

Hello Dr.
Shi, I had a fracture of the distal tibia and fibula in June of last year, and I underwent intramedullary nailing surgery for the tibia.
Forty days post-surgery (after being bedridden for two months), I began experiencing discomfort in my ankle, with pain worsening as I started to bear weight and walk.
At times, I experienced pain for over ten hours a day, including during sleep.
The pain is described as a burning or sharp sensation while walking.
In April of this year, a 1.5 cm protrusion developed on the upper part of the fibular head on the lateral side of my ankle, which is very painful to touch.
My attending physician removed two screws from the intramedullary nail in July to alleviate the symptoms.
Now, three months later, I can only say that the protrusion remains, with slight improvement (the duration of pain has decreased by a few hours).
An ultrasound examination showed fluid accumulation.
Daily heat therapy reduces the size of the protrusion, but it hardens again at night.
Multiple sessions of ultrasound therapy during rehabilitation have not helped, and an orthopedic doctor suggested it might be a cyst.
Could this be a ganglion cyst? Which specialty should I consult (orthopedics or surgery)? Is an MRI necessary for diagnosis? Thank you.

Mr. Su, 50~59 year old female. Ask Date: 2021/10/25

Dr. Shi Guozheng reply Orthopedics

The information you provided is insufficient to determine if it is a ganglion cyst.
If aspiration with a syringe yields a thick, transparent fluid, you may want to consult another orthopedic surgeon for further evaluation.
Additional examinations may be necessary, and it is essential to rely on the physician's judgment.

Reply Date: 2021/10/25

More Info

Ganglion cysts are fluid-filled sacs that commonly develop near joints or tendons, particularly in the hands and wrists, but they can also occur in other areas of the body, including the ankle. They are typically benign and often arise from the synovial fluid that lubricates joints and tendons. Given your history of a tibial and fibular fracture, followed by surgery and subsequent symptoms, it is plausible that the cyst you are experiencing is related to the trauma or surgical intervention.

Symptoms
The symptoms of a ganglion cyst can vary, but they often include:
- A noticeable lump or swelling near a joint or tendon.

- Pain or discomfort, particularly when the affected area is used.

- Increased pain during movement or pressure on the cyst.

- In some cases, the cyst may cause tingling or numbness if it presses on nearby nerves.

In your case, the pain you describe as "sharp" or "cracking" during movement, along with the presence of a painful lump on the fibula, aligns with the typical presentation of a ganglion cyst. The fact that the pain has slightly improved after the removal of hardware from your surgery suggests that the cyst may be contributing to your discomfort.

Diagnosis
Diagnosis of a ganglion cyst typically involves:
1. Physical Examination: A healthcare provider will assess the lump, its size, and tenderness.

2. Imaging Studies: While an ultrasound can help visualize the cyst and any associated fluid, an MRI may provide more detailed information about the cyst's relationship to surrounding structures, especially if there is concern about other underlying issues.

Given that you have already undergone an ultrasound that indicated fluid accumulation, an MRI could be beneficial to confirm the diagnosis and rule out other potential causes of your symptoms, such as a tendon injury or other soft tissue abnormalities.

Treatment Options
Treatment for a ganglion cyst may vary based on symptoms and the cyst's impact on daily activities. Options include:
- Observation: If the cyst is not causing significant pain or functional impairment, it may simply be monitored over time.

- Aspiration: A healthcare provider may use a needle to drain the fluid from the cyst, which can provide temporary relief. However, cysts often recur after aspiration.

- Surgery: If the cyst is painful or limits function, surgical removal may be recommended. This involves excising the cyst and its stalk to reduce the chance of recurrence.

Next Steps
Considering your symptoms and the ultrasound findings, it would be advisable to consult with an orthopedic specialist, as they can assess the cyst in the context of your previous injury and surgery. If the orthopedic evaluation suggests that the cyst is indeed a ganglion cyst, they may recommend further imaging (like an MRI) and discuss appropriate treatment options based on your specific situation.

In summary, while your symptoms and the ultrasound findings suggest a ganglion cyst, further evaluation by an orthopedic specialist and possibly an MRI will help confirm the diagnosis and guide treatment. It’s important to address these symptoms, especially since they are affecting your quality of life.

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