Ganglions generally grow out of a joint or a tendon and are of varying sizes—very small to even bigger than a cherry. In most cases, they appear suddenly and may get bigger in size as the activity increases and more fluid gets collected. Sometimes, they may even shrink, break and disappear on their own.

Anyone between the age of 15 and 40 can get a ganglion; children usually do not get one, and if they do, it disappears on its own.

Causes

Experts do not know the exact cause of ganglions yet. In most cases, they may be caused due to:

• Inflammation or irritation of the tendon sheath or joint capsule
• Injury
• Overuse or repetitive movement
• Arthritis of the hands is a cause for ganglions. It usually affects the joint nearest the fingernail.

Symptoms

Ganglions are usually painless and do not cause other symptoms. In some people, the bump is tender to touch with some pain. The pain worsens with activity or pressure. Sometimes, it may put pressure on the nearby nerves, thus causing a tingling sensation in the fingers, the hand, or the forearm. In rare cases, ganglions can weaken grip or affect movement in the joints.

Diagnosis

Physical examination is the best diagnosis. Most doctors feel the ganglion and shine a light alongside it. If the bump is a ganglion, the light shines through it, thus confirming diagnosis. However, in cases where the doctor suspects arthritis or an injury, an X-ray may be suggested. If it persists, then the fluid may be removed and examined.

Treatment

Ganglions that are painless do not require treatment; they go away on their own. But if they cause pain or limit movements, treatment may be needed. Some people may also opt for treatment due to aesthetic reasons.

Some treatment options include:

• Using a wrist or finger splint intermittently for some weeks. This limits movement and reduces fluid accumulation in the area. But be careful to not use the splint too tight as it may hamper blood supply to that area.
• Massaging/rubbing the area gently often during the day may remove the fluid out of the lump. But, do not rub it too hard or smash it as it may injure the wrist.
• Draining fluid from the bump with a needle.
• Injecting hydrocortisone [corticosteroid used to treat arthritis pain and inflammation] into the joint for the ganglion that occurs with arthritis. This may reduce inflammation and the chance of it reappearing.
• Surgery.

Research shows that ganglions on the wrist return in almost nine out of 10 people. So, that’s normal. As long as the ganglion does not interfere in your daily activities, you may ignore it. But report it to the doctor as soon as the pain increases and it starts hampering normal functioning.

This was first published in the March 2012 issue of Complete Wellbeing.

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A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones of a joint. Arthritis develops as the cartilage begins to deteriorate or is lost. In severe cases, when the articular cartilage is gone, the thickened bone ends rubbing against each other and wear away. This could lead to pain, stiffness, swelling, and – at a later stage – deformity.

Arthritis can affect the person at any age and any joint of the body. The most common cause is age-related degeneration known as osteoarthritis, which usually starts at 55-60 years of age. The other common cause is rheumatoid arthritis, which usually affects younger people between the age group of 20-30. In its acute form, arthritis can cripple the person severely. This could affect lifestyle and put constraints on daily activities and job. There could also be trouble participating in everyday personal and family joys and responsibilities. Psychologically, depression, anxiety, and feelings of helplessness could set in.

Neglected disease

As life expectancy is increasing, the number of people suffering from arthritis is also going to increase. Unfortunately, its prevention and early management is neglected by most people. This is entirely due to lack of awareness of the problem and seriousness of the disease in advanced stage.

“India is expected to be the chronic disease capital, with 60 million people with arthritis, by 2025. The government, the private sector, the medical fraternity and NGOs should come together against the onslaught of chronic diseases.” This statement was quoted by Piramal Healthcare Ltd in a nationwide campaign against chronic diseases recently.

Living with a chronic condition like arthritis/rheumatism can affect people emotionally and impact their quality of life. However, there are many ways of coping with these challenges. This year the theme for World Arthritis Day [12th October] is “Think Positive”. This theme acknowledges that the challenges associated with arthritis/rheumatism can get the person down emotionally. But, there are a number of positive things one can do to help one self feel better and get more from life.

There is a need to raise awareness of arthritis in all its forms among the medical community, people with arthritis, and the general public. This is to ensure all people with arthritis and their caregivers are aware of the vast support network available to them. At Dr L H Hiranandani Hospital Powai, Mumbai, there is an Arthritis Support Group – “Joints in Motion”. Once a month, there is a meeting where people suffering or even not suffering from arthritis are invited to spread awareness/knowledge regarding arthritis, its prevention and management. Every person who comes to attend this programme develops a positive view to life. Operated patients with joint replacement interact with those affected with arthritis. This builds confidence and positive attitude towards the needed treatment. This can help millions of patients who suffer acutely and lose hope of becoming well and enjoying life.

Prevention and treatment

The most important aspect of arthritis is prevention. Many factors could help here. The genetic factors and age related degeneration are not under control. Increased body weight, repeated injuries to the joints, lack of exercise and fitness regime and unhealthy eating habits can increase the risk of developing early arthritis. If everyone becomes conscious about these factors then pain, suffering and burden can be reduced to a great extent.

In general, treatment of arthritis depends on the stage of the disease. In the early stage of the disease, physiotherapy or exercises help. Many people with arthritis don’t exercise because they are worried it will increase their pain, or they are unsure what type of exercise to do. But exercise can have enormous benefits for people with arthritis – it can improve joint mobility, strengthen muscles and bones, increase energy levels and general well-being. Regular exercise can not only help your arthritis, general health and well-being, it can also be enjoyable, improve your self-esteem and make you feel more positive about yourself. When a joint is inflamed, you should avoid rapid, jerky movements, bouncing when you are stretching, forcing joints, and high-impact exercises on damaged joints, such as running on hard surfaces or playing squash and doing strengthening/resistance exercises.

Medications and injections in the joints to reduce pain and increase lubrication also have a major role. Varieties of surgical treatments are also available for complete relief of pain. These could vary from arthroscopic lavage – cleaning of inflamed joint, osteotomy – correction of weight bearing angle of the joint, unicompartmental replacement – affected part of joint being changed with artificial joint and total joint replacement. In the advanced stage of arthritis, cure is possible by joint replacement surgery with excellent long term results. Commonly, knee and hip joint can be changed but shoulder and elbow replacement surgeries are also common. There are always many questions in the mind of patients undergoing joint replacement surgery. I would like to arrange these in following order.

Who is a potential candidate for knee or hip replacement?

When pain in the knee or hip severely limits the ability to walk, work or perform even simple activities, a joint replacement may be an excellent option. In some cases, when an individual has the problem in both knees [or both hips], fixing one can reduce the stress on the opposite joint, thus putting off having the second surgery for several years.

What is total knee replacement surgery?

Total knee replacement surgery involves the resurfacing of the knee joint. Metal components are cemented to the ends of the bones and a plastic liner is inserted between them. The knee cap is also resurfaced with a plastic liner. When in place, these components move together to allow normal motion of the knee joint.

What is total hip replacement surgery?

Hip replacement surgery replaces arthritic hip joint with an artificial joint composed of a ball component and a socket component. The metal ball is attached to a stem that fits into the thigh bone. This component can be cemented or non-cemented depending on age and the condition of bone. A plastic liner with an outer metal shell is secured into the pelvis. A combination of a cemented ball and a non-cemented socket also may be used.

How long can patients expect to be hospitalised after surgery?

Hospital stay is five days for total knee replacement as well as total hip replacement. With the new minimally invasive computer assisted procedures being done, I relieve patients out of the hospital sooner, with less pain and a faster overall recovery.

How will the post-operative pain be controlled?

Thanks to advances in medication technology, we are able to keep patients very comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain of arthritis endured by most people in months and years before surgery.

I pay considerable attention to pain management. Post-operative pain will be treated with PCA [patient controlled analgesia] pump by keeping epidural catheter in the back and post operative pain management protocol. Our goal is to manage pain effectively and maximise comfort.

How long does it take to recuperate?

Recovery varies with each person. Generally, patients begin physical therapy the day after surgery. Once home, some patients use a walker for two weeks to protect the new joint while it heals. It usually takes 2-4 weeks to get back behind the wheel. Most people gradually increase their activities during the next 6-8 weeks.

What results can you expect from a joint replacement?

Generally, total joint replacement is successful. Pain is relieved, deformity corrected, and patients resume former activities and enjoy an active lifestyle. Long term success rates vary from 15-20 years, depending on age, weight, and activity level.

How successful is joint replacement?

Both knee and hip joint replacements are recognised as miracles of modern surgery. Most orthopaedic specialists consider it the best way to treat the pain and restore the loss of mobility from severe arthritis. It has allowed thousands of people with arthritis to get back on their feet and resume an active lifestyle.

So, with proper guidance and treatment it is possible to lead a normal life. The most important thing is to reduce the psychological burden of those afflicted with arthritis. So far, no one in the world has died because of arthritis but there is large amount of suffering due to the disease. If one is aware of the facts of arthritis and its management, and has a positive outlook, he or she could be completely free of pain.

I would like this year’s campaign to focus on improving access to psychological support and self-management courses for patients, to help enable people with arthritis/rheumatism to contribute fully to society and lead independent and fulfilled lives. On World Arthritis Day, I request people with arthritis from around the world to come together and make their voices heard to raise awareness about arthritis.

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At different stages of this natural wear out process, different kinds of treatment are recommended. These vary from simple physiotherapy, prescription of medications to surgery. Types of surgical treatments depend upon the stage of arthritis. Joint replacement surgery is advised to patients having painful, advanced arthritis even after trying all other kinds of treatment.

Joint replacement technique

Joint replacement is a surgical technique where arthritic joint surfaces [worn out cartilage] are replaced by an artificial material made of high grade metal, plastic or ceramic. These provide complete and permanent relief from pain. Patients usually have some apprehension regarding the consequence of this surgery. Therefore, they must first try and understand the whole procedure in detail before undergoing surgery. An experienced surgeon and a reputed hospital are also crucial factors to be considered.

Pain management

Patients about to undergo this surgery are anxious about the post-operative pain and recovery. This is usually taken care of by an efficient anaesthetist team. They can control pain by various programmes. One is the epidural analgesia, where a small epidural tube [which delivers continuous pain-killers] is put in the spine for 2-5 days. Other modalities include intake of pain killers, either orally or by injections – local, intravenous or intramuscular.

Physiotherapy and movement

The success of joint replacement surgery solely depends on competent post-operative care, in the form of physiotherapy rehabilitation programmes. This is usually started 24 hours after surgery. For five post-operative days, patients are taught to walk with a walker and then with a stick. Patients are also made to undergo a range of exercises for movement and strength.

Before discharging the patients from the hospital, they are trained to do day-to-day activities on their own. The extensive physiotherapy programme is then continued for another six weeks. Later, patients have to continue this by themselves throughout their life. Conventional knee replacement provides 90-100 degrees bending after surgery. However, a new technology known as RPF [Rotating Platform Flex] allows patients to sit cross-legged, kneel and even perform other routine activities where complete bending of the knees is essential.

Computer navigation surgery

A well done joint replacement usually lasts for 10-15 years. Longevity of joint replacement depends on – proper sizing and alignment of components of the artificial joint, alignment of the leg, and balancing of the ligaments of the joint. These can be accurately done to a high level of precision using computer navigation system – which is not possible with conventional methods. Such a joint replacement can last up to 20 years or more.

Another advantage of this technique is that both knees [bilateral knee replacement] can be replaced at the same time very safely. Here the incision or skin cut is very small and with the help of proper pain management recovery is very quick. More than 90 per cent people who have joint replacement surgery will never need revision surgery. Revision surgery is becoming common because younger people go through these surgeries and wearing away of the joint surface becomes a problem after 15-20 years.

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