Ganglion Cysts in the Wrist

Dorsal wrist ganglion and volar wrist ganglion

INTRODUCTION

A ganglion cyst is a tumor or swelling on top of a joint or the covering of a tendon (tissue that connects muscle to bone). It looks like a sac of liquid (cyst). Inside the cyst is a thick, sticky, clear, colorless, jellylike material. Depending on the size, cysts may feel firm or spongy. One large cyst or many smaller ones may develop. Multiple small cysts can give the appearance of more than one cyst, but a common stalk within the deeper tissue usually connects them. This type of cyst is not harmful and accounts for about half of all soft tissue tumors of the hand.

They are more common in women, and 70% occur in people between the ages of 20-40. Rarely, ganglion cysts can occur in children younger than 10 years.

Ganglion cysts most commonly occur on the back of the hand (60-70%), at the wrist joint and can also develop on the palm side of the wrist. When found on the back of the wrist, they become more prominent when the wrist is flexed forward. Other sites, although less common, include these:

• 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 CAUSES

The cause of ganglion cysts is not known. One theory suggests that trauma causes the tissue of the joint to break down forming small cysts, which then join into a larger, more obvious mass. The most likely theory involves a flaw in the joint capsule or tendon sheath that allows the joint tissue to bulge out.

SIGNS AND SYMPTOMS

The ganglion cyst usually appears as a bump (mass) that changes size.

It is usually soft, anywhere from 1-3 cm in diameter (about .4-1.2 inches) and doesn’t move.

The swelling may appear over time or appear suddenly, may get smaller in size, and may even go away, only to come back at another time.

Most ganglion cysts cause some degree of pain, usually following acute or repetitive trauma, but up to 35% are without symptoms, except for appearance.

The pain is usually nonstop, aching, and made worse by joint motion.

When the cyst is connected to a tendon, you may feel a sense of weakness in the affected finger.

HOME CARE

In the past, home care has included topical plaster, heat, and various poultices. It even extended to use of a heavy book to physically smash the cyst (sometimes this is called “Bible therapy”). These forms of treatment are no longer suggested, however, because they have not been shown to keep the ganglion cysts from returning and could, in fact, cause further injury.

WHEN TO CALL THE DOCTOR

Whether you have symptoms or not, your ganglion cyst can benefit from medical evaluation. Your doctor can be sure that you have a ganglion cyst, keep you from worrying, and help decide on the best treatment plan for you.

WHEN TO GO TO THE HOSPITAL

A ganglion cyst does not need to have emergency treatment unless you have significant trauma. A routine check by either your doctor or a specialist in bones and joints (an orthopedist) should be enough.

PHYSICIAN DIAGNOSIS

A physical exam is often all that is needed to diagnose a ganglion cyst.

Your doctor may get further confirmation by using a syringe to draw out some of the fluid in the cyst (needle aspiration) or ultrasound. Ultrasound is a type of sound x-ray. It can determine whether the bump is fluid-filled (cystic) or if it is solid. Ultrasound can also detect whether there is an artery or blood vessel causing the lump.

Your doctor may send you to a hand surgeon if the bump is solid or involves a blood vessel (artery).

Magnetic resonance imaging (MRI) is used to see the wrist and is very useful for ganglions. One drawback to this diagnostic method is the cost of the procedure.

PHYSICIAN TREATMENT

Many cysts (38-58%) can disappear without any treatment at all.

Various treatments have been proposed over the years. Some include telling people with cysts without symptoms not to worry, using a needle to remove the cyst’s contents (aspiration), or surgery.

Aspiration usually includes placing a needle into the cyst, drawing the liquid material out, injecting a steroid compound (anti-inflammatory), and then splinting your wrist to keep it from moving.

Studies have shown up to 74% of people are cured after having the fluid drawn out with a needle 1 time.

If you have the fluid drawn out 3 times, your possibility of being cured goes up to 85%, particularly with a cyst on the back of the hand.

If you compare aspiration/injection and surgical removal, in general, cysts return less often after surgery.

Surgical removal of the cyst is needed when the mass is painful, interferes with function (especially when your dominant hand is involved), or causes numbness or tingling of the hand or fingers.

PROGNOSIS

Because this is a harmless tumor that can go away on its own, or after a simple needle aspiration or minor surgery, chances are good that you will have a full recovery. Because ganglion cysts may come back after any of these treatments, however, a single treatment may not be enough.

PREVENTION

Because the cause of a ganglion cyst is not known, it is difficult to tell how to prevent them. Early evaluation and treatment are recommended.

FOLLOW-UP

After you have been diagnosed with a ganglion cyst and have chosen to have treatment, follow up will be different based on what you have chosen to do.

After simple aspiration, your doctor may ask you to start moving the joint soon after the procedure.

Most likely after surgery, your joint will be splinted for up to 7-10 days. A splint is a hard wrap that will keep you from moving your joint.

Recent studies show that splinting for a long period of time doesn’t really help, and use of the joint soon after treatment is being encouraged.

Your doctor may ask you to return for a check-up after your surgery and will decide if physical or occupational therapy is needed. Follow-up care will be based on your personal needs.