A ganglion is a small cyst, or sac of clear, mucus-like fluid that can grow in one of many locations on the wrist, although they are most common on the back of the hand at the wrist joint. Other sites, although less common, are the underside of the wrist, the base of a finger, or the end joint of a finger. Most often, ganglion cysts are harmless and will disappear over time.
Ganglion Cysts arise from the connective tissues between bones and muscles. Doctors don’t know specifically what causes ganglion cysts to develop. We do know that women are more likely to be affected than men, and these cysts are common in gymnasts, possibly due to the repeated application of stress to the wrist. Many patients present with a wrist has been previously injured, so repetitive injuries play a role in the formation of ganglion cysts. One theory suggests that the degeneration of connective tissue may cause cysts to develop. The damaged tissue forms a weakened spot in the joint capsule, which begins to leak fluid. This fluid begins to collect in an area outside of the joint, forming the cyst. Studies show that the fluid inside the ganglion is a mix of chemicals found in the joint, which may support the idea that the joint fluid moves from the wrist into the ganglion, somewhat like a Baker’s Cyst does behind the knee joint.
The most common symptom is the appearance of the cyst as a bump under the skin. It may appear suddenly or it may grow over time. Cysts are typically 1-3 centimeters in diameter and do not move. The size of the bump may change. It might get smaller in size, or it may even go away and appear again at another time. The reason for this is likely related to your joint’s activity level. The lump will generally decrease in size with rest, and the more active the joint, the larger the cyst becomes. Most ganglion cysts do cause some degree of pain, but approximately 35% have no symptoms other than appearance. If pain is present, it is usually persistent and made worse by joint motion.
Whether or not you have symptoms, it is a good idea to have your ganglion cyst evaluated by a doctor to determine the best treatment plan for you. I would want to rule out other conditions, such as a bone tumor or arthritis. I would ask a series of questions, such as how long you’ve had the bump or swelling, your pain level, and its growth pattern. I may press on it to assess its tenderness. I may order an X-ray or ultrasound to rule out other conditions.
In the past, self-care at home consisted of topical plaster, heat, and various homemade solvents. Some even used a heavy book to smash the cyst. All of these treatments are no longer suggested because they could cause further injury and they have not been shown to keep the cyst from returning. Nowadays, we use more sophisticated treatments than slamming a book on the patient’s wrist. Many cysts will disappear without any treatment. Prior to recommending surgery, we have a few options:
• Observation is one of the most common plans of care. We will wait and watch to be sure no unusual changes occur to its appearance and the level of discomfort it is causing.
• Immobilization will help relieve symptoms. As I previously mentioned, activity often causes the ganglion to grow. A wrist brace or splint may decrease the pain, reduce symptoms, and cause the cyst to shrink. As pain decreases, I recommend exercises to improve the strength in your wrist.
• Aspiration offers a great level of success. The area around the cyst is numbed and I puncture the cyst with a needle to drain its fluid. I will also inject an anti-inflammatory into the area to relieve the pain and prevent swelling. Studies show that up to 74% of those who have this procedure see complete relief after aspiration of the fluid just once.
When the cyst is painful, interferes with function, or causes numbness or tingling of the hand and fingers, I will recommend surgery to remove the cyst. While there is no guarantee that the cyst will not grow again, you will experience major relief. After this simple outpatient procedure, you will be splinted for about a week. Depending on your personal needs, you may require occupational therapy for a short time after surgery. Normal activities are usually resumed two to six weeks after surgery.
If you have what you believe to be a ganglion cyst, I recommend that you make an appointment to see me and we’ll get you on the path to feeling better!
Robert J. Snyder, MD is a board-certified Orthopaedic Specialist with Orthopaedic and Spine Center in Newport News, Virginia. Dr. Snyder’s practice is focused primarily on sports-related injuries and disorders, and on total and partial joint replacements of the hip and knee, including the ConforMIS knee replacement system. Call 757-596-1900 to make an appointment. Visit www.osc-ortho.com to learn more about OSC and Dr. Snyder.