Wrist Ganglion Cyst

Lumps on the Back of the Hand

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A wrist ganglion cyst is a swelling that usually occurs over the back of the hand or wrist. These are benign, fluid-filled capsules. Ganglion cysts are not cancerous, will not spread, and while they may grow in size, they will not spread to other parts of your body.

Ganglion cysts are in fact not even "true cysts," but rather arise as pouches of fluid that comes from the small joints of the wrist, or from fluid within the sheath that surrounds the wrist tendons.

When the fluid, called synovial fluid, leaks out from these spaces, it can form a sack-like structure that we call a ganglion cyst.  The fluid within the ganglion cyst is identical to the normal fluid found within a joint or within a tendon sheath. The fluid is gelatinous, and looks and feels like jelly.

Lumps and Bumps of the Hand and Wrist

It is important to have this type of lump checked by your doctor to ensure it is simply a ganglion cyst. While most lumps and bumps of the hand and wrist are ganglion cysts (by far the most common), there are other conditions that have different treatments. Other type of tumors such as a lipoma or giant cell tumor, infections, carpal bossing (bone spur), and other conditions can cause lumps around the wrist.

Ganglion cysts are typically found on the back of the wrist (a dorsal wrist ganglion), although they can also be found on the palm side of the wrist (volar ganglion).

  Ganglion cysts may be tender, but most often it is the appearance of the cyst that bothers patients.  The cyst should not adhere to the skin, and the skin should have normal color.  One test to diagnose a ganglion cyst is to hold a light source, such as a small flashlight, against the cyst.  A normal ganglion cyst will trans-illuminate, meaning light will pass through the cyst indicating it is not a solid mass.

Treatment of a Ganglion Cyst

Sometimes, wrist ganglion cysts go away with no treatment, or they may linger around or even grow larger. The cysts typically form a type of one-way valve such that fluid enters the cyst easily, but cannot escape. When the ganglion cyst becomes large enough, it will begin to put pressure on surrounding structures. This pressure can cause painful symptoms, and is usually the reason these ganglion cysts are removed.

There are several methods of treatment for a wrist ganglion cyst. Putting a needle into the ganglion cyst and aspirating the fluid may work. However, the gelatinous fluid within the cyst does not always come through a needle very well. Furthermore, this treatment leaves the cyst lining behind, and the ganglion cyst will return about 50% of the time.

Another alternative, that some call traditional, others call a bit barbaric, is to smash the wrist ganglion cyst with a hard object such as a book. This pops the cyst, and ruptures the lining of the cyst. While many people are familiar with this treatment, it is not considered acceptable as there is the potential for other damage from the trauma of the treatment. In fact, there are rare reports of fracture of the bones around the wrist associated with overzealous efforts to crush the cyst.

The most aggressive treatment for a persistent or painful ganglion cyst is to remove it with a surgical procedure. During surgery, the wrist ganglion is completely excised, including the sac that surrounded the fluid. In addition, the connection to the joint or tendon sheath that supplied the fluid can be occluded. While this usually is effective, a small percentage of removed wrist ganglion will still return. Surgical treatment has been well described both as an open surgical procedure (through a skin incision) and as an arthroscopic procedures. Different surgeons have preferences for their favored approach.

Lastly, many hand and wrist experts recommend no treatment for cysts at all. While some people don't like the look of a ganglion cyst, and some people have discomfort, the cysts are generally not harmful, and many patients feel much better once reassured that the cyst is not going to cause any long-term problem. Particularly with volar ganglion cysts, the treatment can be problematic, and complications including infection, tendon injury, and recurrence of the cyst can all occur. If the cyst can be tolerated, many expert advise they be left alone.

Sources: Thornburg LE. "Ganglions of the hand and wrist" J Am Acad Orthop Surg. 1999 Jul-Aug;7(4):231-8.

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