A ganglion, commonly known as overbone, is a swelling under the skin. It usually occurs on a tendon sheath or joint capsule of the hand, but can also be found on the foot and sometimes the knee.
What is an over leg?
The ganglion is a cyst, i.e. a fluid-filled chamber in the tissue that is located under the skin. The cyst communicates with a joint capsule or with a tendon sheath that is below it.
The ganglion has the term overbone (with “leg” in the old sense of bone) because it shows up as a swelling outwards. The swelling is called a soft tissue tumor by doctors, but this tumor is harmless.
The fluid in the cyst is made up of hyaluronic acid. A ganglion is often found on the hand, less often on the foot or knee.
How exactly a ganglion arises is not yet fully understood. One cause that is believed to be possible is tears in the tendon sheath or in the joint capsule. Such cracks can occur if there is more synovial fluid.
If the amount of fluid becomes too large, it penetrates through the tear into the surrounding tissue and forms a cyst there. This ganglion is then connected to the place of origin, i.e. the tendon sheath or the joint capsule. Why there is increased production of synovial fluid is unknown. Congenital disorders, overload due to movements or overstimulation are suspected.
Hormonal causes cannot be ruled out either, because women are around three times more likely to have a ganglion than men. If a ganglion has already formed, movement will usually enlarge it.
Symptoms, ailments & signs
Over-legs usually appear on the back of the hand, wrist or fingers, but in rarer cases also on the back of the foot, knee, elbow or shoulder. Those affected first notice a bump. This typically has the shape of a plump lump or an ovoid-oval swelling. A ganglion can be up to two centimeters in size.
However, some are only a few millimeters in size and are discovered by accident or go completely unnoticed. It is also possible that several ganglia form next to each other. If the ganglion is of a certain size, it can also be seen by others.
Often the over-legs do not cause any pain in those affected. In other cases, severe pressure pain can occur, which can also spread to other areas. An excess leg on the wrist can also make itself felt as an elbow pain.
This can massively restrict the person’s freedom of movement. Larger ganglia can also impress nerve tracts and vessels. This can lead to numbness and tingling in the limbs. The pressure on the vessels can also lead to bleeding and subsequently to infections.
The course of the disease in a ganglion can show itself in different symptoms. In any case, the ganglion can be seen optically as a swelling or sometimes just palpated. The severity of pain in people who have a ganglion is very different.
For some people it only causes pain when it is exposed to pressure, while others feel a clear constant pain.
If the ganglion has formed in the area of nerve tracts, it can also lead to a numb feeling. It also happens that the ganglion does not show itself as an excess leg, but does not develop on the joint that is visible from the outside. With this course of the disease, symptoms often appear in the form of joint pain caused by the ganglion.
The ganglion primarily causes severe swelling and pain. The pain is stabbing and can also spread to other regions of the body, where it can lead to severe pain and other complaints. It is not uncommon for the joints to feel numb and this leads to sensory disturbances and restricted mobility in the patient.
As a rule, the everyday life of the person affected is severely restricted by a ganglion and the quality of life is reduced. The pain can be either pain at rest or pressure pain. Pain at rest can lead to sleep disorders and general irritation in the patient. In addition, these usually have a negative effect on the patient’s psyche.
As a rule, there are no complications during treatment. The treatment only has to take place if the ganglion really causes discomfort. Above all, exercises and therapies are used. A ganglion without symptoms is usually not treated and does not lead to any complications. In severe cases, treatment can also take place with the help of medication.
When should you go to the doctor?
If there is any unusual swelling or growth on the hand, foot or knee, a check-up should be initiated by a family doctor. If this swelling suggests that there is fluid in it, it could be a ganglion. Since treatment should take place, a medical clarification of the observation is necessary.
If the changes in the complexion of the skin lead to difficulties in movement sequences or if everyday activities can no longer be carried out as usual, a doctor’s visit is necessary. If numbness or sensitivity disorders occur in the affected area, a medical professional should determine the cause.
In the event of pain or discomfort, a doctor is required before pain reliever medication is taken. If the growth on the extremities increases or the impairments increase, a doctor should be consulted as soon as possible.
If there are problems with the joints or if there is one-sided physical strain, the patient is at risk of further illnesses if he does not seek medical treatment. If you experience tension or pressure, emotional distress or irritability, a doctor should be consulted. If you experience stress or if your normal performance deteriorates, it is advisable to ask a doctor for help.
Treatment & Therapy
A ganglion doesn’t always cause pain or other discomfort. If this is the case, therapeutic measures should initially be avoided, as a ganglion often regresses spontaneously. If, on the other hand, the ganglion is associated with pain or other complaints, such as restrictions in movement function, conventional therapy is carried out first.
Various methods are used for this. Physiotherapy treatment can help if the pain is only mild. Another option is to use a puncture to remove the fluid from the cyst. Cortisone injections can be used to reduce the swelling. Another possibility of drug treatment consists in injecting hyaluronidase.
This causes a breakdown of the hyaluronic acid in the cyst and the ganglion recedes. If these procedures don’t work or the pain is too severe, surgical removal of the ganglion may be necessary. During the operation, not only is the cyst removed, but the tear that caused the ganglion to form is also closed.
Outlook & forecast
The excess leg has a favorable prognosis. Spontaneous healing is documented in many patients, as the synovial fluid that is formed can be removed from the organism at any time. This leads to a regression of the ganglion and freedom from symptoms for the patient.
Long-term consequences are not to be expected. The range of motion is fully restored so that the patient does not have to expect any impairments. Despite possible spontaneous healing, a new ganglion can develop at any time in the course of life. In these cases, the prognosis remains positive.
If the upper leg does not recede by itself, only medical treatment can bring about relief. In addition, there is a risk that the swelling will increase in the further course without therapy. This leads to an increase in the symptoms and triggers a restriction in mobility. Regardless of the choice of treatment method, there will be rapid recovery under optimal conditions.
If no further complications arise, the patient is discharged from treatment within a few days or weeks. Usually a follow-up visit is scheduled after a few months to check whether there has been a new accumulation of synovial fluid and mobility has been fully restored. Possible bad posture or incorrect loads are checked and, if possible, corrected immediately.
Even if it has not yet been fully clarified why a ganglion arises, the relation to incorrect joint stress is obvious. Exercises that relax the joints are therefore recommended for prevention. This is particularly important when the joints are exposed to heavy loads, for example when working on a computer. A ganglion can be prevented with the help of stretching exercises and loosening of the arm and hand muscles, which also allow the joints to move properly.
If the ganglion is surgically removed, the wound must be checked regularly for the first few days afterwards. This means that inflammation or swelling is detected early on. By applying an elastic bandage, bleeding and fluid accumulation in the wound area can usually be avoided.
It is not always necessary to immobilize the affected joint, but it will reduce the pain in the first few days after the operation. If a ganglion is removed on the flexor side of a joint, a splint makes perfect sense. If the wound is healing well, the bandage is renewed two to three times in the first week and the sutures are removed between the 10th and 14th day.
A bandage is usually no longer required one to two days after removing the sutures. After the operation, the joint should be slowly and gradually fully loaded. If this is forced too quickly, the ganglion can recur, causing swelling and pain. Regular baths of the affected area in cold or lukewarm water have a beneficial effect.
Rubbing the surgical scar thinly with a fatty ointment makes the tissue softer. In most cases physiotherapy or occupational therapy is not required. As a rule, the incapacity for work is three to four weeks.
You can do that yourself
The ganglion can be treated by the person concerned, provided the ganglion does not cause pain or the movement of the person concerned is not restricted. In this case, no surgical removal is necessary. However, this should be clarified in advance by a doctor.
The affected person can treat the ganglion with healing clay. Healing earth consists of minerals and is either applied directly to the ganglion or the healing earth is first heated and then applied. Either option should provide ganglionic relief. Alternatives to the healing earth are poultices with the comfrey ointment or arnica ointment. The ganglion can also be treated with horse ointment.
If the ganglion does not improve, it can also be treated with cortisone and pain relievers, which the patient is prescribed by a doctor. In combination with a temporary fixation of the affected area, this can lead to an improvement.
If these measures do not lead to any improvement, a doctor should be consulted. If the ganglion is not causing any discomfort at all, then it cannot be treated. It is possible for it to burst upon impact, and the fluid that escapes from the cyst will then be absorbed by the body. The ganglion is now removed and no further steps are necessary.