Ganglion

Ganglion (ganglion), a cystic formation that most commonly develops from a joint capsule, and less frequently from a tendon sheath. The typical location for a ganglion is the dorsal surface of the wrist joint (see illustration), specifically the depression between the tendon of the flexor digiti minimi and the tendon of extensoris carpi radialis brevis (dorsal carpal ganglion). Ganglia have been described (in isolated observations) in the area of the knee joint. Previously, ganglia were considered to be retention cysts, but more recent research (Raug and others) has shown that ganglia are the result of colloidal degeneration of a section of the joint capsule, apparently of traumatic origin. Clinical experience also supports the traumatic origin of ganglia; they are often encountered as a professional disease among certain groups of workers whose activity is associated with constant mechanical irritation of the wrist joints (for example, dentists, pianists, typists), more frequently in women than in men. In addition to cosmetic inconvenience, ganglia cause fatigue in the forearm muscles, which sometimes turns into a dull, aching pain. These sensations often force patients to even abandon their work.

Small ganglia are recommended to be removed by crushing - the hand is placed on something soft (usually a sandbag), a plate, for example, a copper coin, is placed on the ganglion, and the ganglion is crushed with a wooden mallet; puncture with a thick needle and aspiration of the contents (a thick, viscous, colloidal transparent mass) with a syringe, injection of iodine and other irritating substances are used. All these methods, however, more often than not lead to recurrences. A more radical approach is the extirpation of the ganglion, and it is necessary to maintain the strictest asepsis, since it is necessary to open the joint. After the operation, a significant swelling of the forearm and hand often occurs. Neumuller and Orator proposed not removing the cysts (since

removal sometimes does not prevent recurrence), but, after exposing and opening the ganglion, to sew its edges to the surrounding cellular tissue, thereby creating an internal drainage into the subcutaneous tissue, similar to operations for ascites (see).