Homoeopathic management of ganglion cyst

Dr Vishnuvardhan Reddy

ABSTRACT
Ganglion is a swelling usually seen over the back of the hand at the wrist joint or at any joint surfaces, which is the most common soft tissue tumor in hand and wrist, predominantly seen in females. Even though it is a harmless and painless swelling, swelling over the hand causes unacceptable appearance. In painful situations in the allopathy the treatments available are pain relieving medications and excision of swellings. Homoeopathy can be an alternative in treatment of ganglion.

KEYWORDS: Ganglion, swellings of wrist and hand, homoeopathy.

INTRODUCTION

A ganglion cyst is a small sac of fluid that forms over a joint or tendon.

Ganglion cysts most commonly show up on the back of the hand at the wrist joint but they can also develop on the palm side of the wrist.

They can also show up in other areas, but these are less common:

• The base of the fingers on the palm, where they appear as small pea-sized bumps
• The fingertip, just below the cuticle, where they are called mucous cysts
• The outside of the knee and ankle
• The top of the foot

EPIDEMIOLOGY

Ganglion cysts account for 60% to 70% of soft-tissue masses found in the hand and wrist.

Although they can form at any age, they are most commonly found in women between the ages of 20 to 50.

Women are three times more likely to develop a ganglion cyst than men.

These cysts are also frequently encountered amongst gymnasts, likely secondary to repetitive trauma and stress of the wrist joint.

CAUSES

Numerous theories have been presented in the past regarding the etiology of ganglion cysts

1. Theory by Eller in 1746 is that ganglion cysts are the result of the herniation of synovial tissue from joints.
2. Theory by Carp and Stout in 1926, which forms the basis of most modern belief, suggests that ganglion cysts result from mucinous degeneration of connective tissue secondary to chronic damage.
3. Currently, most authors agree that ganglion cysts arise from mesenchymal cells at the synovial capsular junction as a result of the continuous micro-injury. Repetitive injury to the supporting capsular and ligamentous structures appears to stimulate fibroblasts to produce hyaluronic acid, which accumulates to produce the mucin “jelly-like” material commonly found in ganglion cysts.

HISTOPATHOLOGY

Typical histopathological appearance is a mucin-filled synovial cell lined sac without a true epithelial lining. When examined under electron microscopy, their walls contain sheets of collagen fibers arranged in multidirectional layers with intermittent flattened cells resembling fibroblasts. The thick mucinous material present in the majority of ganglion cysts is highly viscous, which is attributed to a high concentration of hyaluronic acid and mucopolysaccharides. Biopsies of ganglion cysts are not routinely indicated because of their inherently benign nature.

CLINICAL FEATURES

Symptoms of a ganglion cyst can include:

• Ganglion cysts usually present as firm, well circumscribed, freely mobile masses approximately 1 cm to 3 cm in size.
• They are often fixed to deep tissue and not to the overlying skin.
• Swelling that may appear over time or suddenly.
• It may get smaller in size or even go away and come back.
• Some degree of pain is possible, especially after acute or repetitive trauma, but many aren’t painful.
• Pain may be chronic and get worse with joint movement.
• When the cyst is connected to a tendon, a sense of weakness is felt in the affected finger.

DIAGNOSIS

X ray — Radiographs may be ordered to rule out any related intraosseous manifestation.

MRI – MRI is usually not indicated for ganglion cysts unless there is a concern for a possible solid tumor. MRI will show a well-circumscribed mass with uniform fluid intensity on T2 weighted imaging.

Ultrasound – Ultrasound can be used to differentiate a cyst from a vascular malformation and to avoid accidental puncture of the radial artery during needle aspiration of a cyst.

DIFFERENTIAL DIAGNOSIS

• Aneurysmal bone cyst is a benign, blood-filled lesion in the bone that tends to expand or grow. It is referred to as a cyst, as it is a true benign bone tumor surrounded by a thin wall of bone. Aneurysmal bone cysts (ABCs) can occur in any bone, but are most commonly found around the knee, pelvis or spine.

• Chondroblastoma is a rare, benign, locally aggressive bone tumor that typically affects the epiphyses or apophyses of long bones. It arises from an outgrowth of immature cartilage cells (chondroblasts) from secondary ossification centers, originating from the epiphyseal plate or some remnant of it.

• Chondromyxoid fibroma grows out of the cartilage-forming tissue found in the marrow of bones. It typically develops in the flared end of a long bone in the lower body, such as the tibia or femur. On X-rays, provide clear pictures of dense structures like bone, and are very helpful in diagnosis.

• Enchondroma is a benign tumor in the cartilage inside of your bones. An enchondroma generally doesn’t cause any pain or other symptoms. On X-rays – Enchondromas show up as small, dark spots in the center of your bones. They contain white spots with patterns of rings and arcs.

• Giant cell tumor is benign, aggressive tumors typically found in the epiphysis of long bones, most commonly at the distal femur and proximal tibia. Patients typically present with insidious onset of pain of the involved extremity with activity, at night, or at rest. Diagnosis is made with a biopsy showing mononuclear stromal cells that resemble interstitial fibroblasts with numerous giant cells dispersed throughout.

• Nonossifying fibroma is benign fibrogenic lesions that result from dysfunctional ossification that are most commonly found in the metaphysis of long bones. Patients typically present between the ages of 5 and 15 with an asymptomatic lesion discovered incidentally on radiographs. Diagnosis is made on radiographs with a characteristic metaphyseal eccentric “bubbly” lytic lesion surrounded by a sclerotic rim.
• Simple bone cyst / Unicameral Bone Cysts are non-neoplastic, serous fluid-filled bone lesions most commonly found in the proximal humerus. The condition typically presents in patients < 20 years of age with a pathological fracture through the lesion. Diagnosis is made with radiographs showing a central, lytic, well-demarcated metaphyseal lesions with cystic expansion and a characteristic “fallen leaf” sign.

INDICATIONS OF HOMOEOPATHIC REMEDIES IN GANGLION

Arnica – indicated in ganglion after acute or chronic injuries. Pain, as if from fatigue, and crawlings in the arms and in the hands. Pain, as of dislocation, in the joints of the arms and hands. Sensation of soreness of the arms. Sensation as if the joints of the arms and wrists were sprained. Want of strength in the hands on grasping anything.

Aurum muriaticum – Swelling in the wrist, without pain, if left alone and tensive only on bending the hand backwards. Stitches in the wrist upon seizing anything.

Baryta carb – indicated in palsy of aged persons. Pains in the joints and in the hollow bones. Cramp-like pressure or pulling, with paralytic weakness, or tension, as if from contraction of the tendons. Violent tingling and gnawing in the palm of the hand, with desire to scratch.

Belladonna – Indicated with swelling with redness of the wrist. Predominantly right sided remedy. Painful startings, cramp and convulsions in the hands. Trembling of the hands. Pressure, with sharp pains in the carpal and metacarpal bones. Very sensitive to the touch and cold weather.

Benzoic acid – Indicated in ganglion of wrist. Complaints starts at the left side and then right side. Tearing and stitches type of pain in the wrists. Chilly remedy and complaints aggravated from open air and better by covering or warmth. The concomitant is strong smelling urine associated with the compalints. Gouty disposition.

Calcarea carbonicum – Pains, as of dislocation, in the wrist-joint. Swelling of the hands. Arthritic nodosities, swelling of the wrist, and of the joints of the fingers. Perspiration of the palms of the hands. Trembling of the hands. Hands and fingers dead, even in a warm temperature, and esp. on taking hold of an object. Frequent paralytic weakness in the fingers.

Carbo vegetalis – Pulling and acute drawing pains in the wrists and the fingers. Tension in the joints of the hand, as if they were too short. Cramp-like contraction of the hands. Heat of the hands; burning in the hands. Icy-cold hands. The tips of the fingers are covered with cold sweat. Paralytic weakness of the wrists and of the fingers, esp. on grasping an object.

Causticum – Drawing pains and acute pulling in hands and the fingers. Paralytic feeling in the right hand. Sensation of fullness in the hands, on grasping an object. Tearing in right wrist joint. Spasmodic weakness and trembling of the hands. Paleness and painful torpor of the fingers. Tension of the posterior joints of the fingers when bending them.

Conium – Indicated in ganglion after over work, old injuries. Numbness of the hands, and esp. of the palms of the hands. Cracking in the wrist-joint. Sweat in the palms of the hands. Torpor of the fingers.

Rhus toxicodendron – indicated in ganglion after the over work , strain or injuries. Jerking tearing in elbows, wrists, and joints of fingers. Digging pains in bones of the forearm. Weakness and rigidity of forearm and fingers during movement, and trembling of those parts after the least exertion. Hot swelling of the hands in evening. Pains are better with warmth application and aggravated during in damp conditions.

Ruta – Pressive and spasmodic drawing and tearing in forearms, hands, and fingers. Paralytic stiffness of wrist. Wrenching pain or shootings in wrists. Sensation as from a sprain and stiffness in wrist. Bones of wrist and back of hand painful as if bruised when at rest and when moving. Pain in wrist (as from a sprain) on lifting a weight. Numbness and tingling in hands after exertion. Spasmodic contraction of fingers.

Sticta pulmonaria – Indicated after falls. Rheumatism of wrists; wrists and hands swollen, little redness, very painful on moving. A spot of inflammation and redness on the affected joint is commonly seen.

Silicea – Ganglion on back of hand. Nocturnal shootings in wrist, extending to the top of arm. Tearing pain in wrists and ball of hand. Spasmodic pain in the hands and fingers. Numbness of hands at night. Paralytic weakness of hands. Tonic spasm of hand when writing. Cramp like pain and lameness of hand after slight exertion. Profuse sweat of the hands. Tingling in fingers. Pain in joints of fingers, when pressed. Weakness, rigidity, and want of flexibility in fingers. Contraction of flexor tendons; very painful when moving fingers.

CONCLUSION

A ganglion cyst is a small sac of fluid that forms over a joint or tendon usually due to repetitive trauma commonly seen in females, in most of the cases it is a painless swelling. in few cases it is a painful with movement of the joint. Can be diagnosed clinically, X – ray is done to differentiate the other bony swellings, in ganglion there is no change in the bony surface. MRI is also a choice of investigation in which uniform well-circumscribed mass is observed. Homoeopathy can become alternative method of choice which can reduce swelling and pain. The success of homoeopathy lies in the ability to individualize the patient and potency.

REFERENCES

1. https://orthoinfo.aaos.org/en/diseases–conditions/ganglion-cyst-of-the-wrist-and-hand/
2. https://www.webmd.com/a-to-z-guides/ganglion-cyst
3. https://en.wikipedia.org/wiki/Ganglion_cyst
4. Clarke JH. The Prescriber. Available from: http://www.homeoint.org/books1/clarkeprescriber/n.htm
5. HERING C. The guiding symptoms of our materia medica Available from: http://www.homeoint.org/hering/s/stann.htm
6. GANGLIONIC CYST. https://www.ncbi.nlm.nih.gov/books/NBK470168/

Dr Vishnuvardhan Reddy
PG Scholar,Department of Practice of medicine
U/G/O Dr Praveen Kumar P. D (HOD of Dept of Medicine)
Government Homoeopathic Medical College and Hospital,
Dr. Siddhaiah Puranik Road, Basaveshwar Nagar, Bengaluru,560079