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Ganglion Cyst of Wrist and Hand

Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in various locations, but most frequently develop on the back of the wrist.

These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment. However, if the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available.

A ganglion rises out of a joint, like a balloon on a stalk. It grows out of the tissues surrounding a joint, such as ligaments, tendon sheaths, and joint linings. Inside the balloon is a thick, slippery fluid, similar to the fluid that lubricates your joints.

Ganglion cysts can develop in several of the joints in the hand and wrist, including both the top and underside of the wrist, as well as the end joint of a finger, and at the base of a finger. They vary in size, and in many cases, grow larger with increased wrist activity. With rest, the lump typically becomes smaller.

Ganglion Wrist Cyst

CAUSES

It is not known what triggers the formation of a ganglion. They are most common in younger people between the ages of 15 and 40 years, and women are more likely to be affected than men. These cysts are also common among gymnasts, who repeatedly apply stress to the wrist.

Ganglion cysts that develop at the end joint of a finger — also known as mucous cysts — are typically associated with arthritis in the finger joint, and are more common in women between the ages of 40 and 70 years.

SYMPTOMS

Most ganglions form a visible lump, however, smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms, if a cyst puts pressure on the nerves that pass through the joint, it can cause pain, tingling, and muscle weakness.

Large cysts, even if they are not painful, can cause concerns about appearance.

DOCTOR EXAMINATION

Medical History and Physical Examination

During the initial appointment, your doctor will discuss your medical history and symptoms. He or she may ask you how long you have had the ganglion, whether it changes in size, and whether it is painful.

Pressure may be applied to identify any tenderness. Because a ganglion is filled with fluid, it is translucent. Your doctor may shine a penlight up to the cyst to see whether light shines through.

Imaging Tests

X-rays. These tests create clear pictures of dense structures, like bone. Although x-rays will not show a ganglion cyst, they can be used to rule out other conditions, such as arthritis or a bone tumor.

Magnetic resonance imaging (MRI) scans or ultrasounds. These imaging tests can better show soft tissues like a ganglion. Sometimes, an MRI or ultrasound is needed to find an occult ganglion that is not visible, or to distinguish the cyst from other tumors.

TREATMENT

Nonsurgical Treatment

Initial treatment of a ganglion cyst is not surgical.

    • Observation. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms, your doctor may recommend just waiting and watching to make sure that no unusual changes occur.
    • Immobilization. Activity often causes the ganglion to increase in size and also increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms and cause the ganglion to decrease in size. As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.
    • Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it.

This procedure is called an aspiration.

The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid can be withdrawn.

Aspiration frequently fails to eliminate the ganglion because the “root” or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not removed. In many cases, the ganglion cyst returns after an aspiration procedure.

Aspiration procedures are most frequently recommended for ganglions located on the top of the wrist.

Nonsurgical Treatment

Initial treatment of a ganglion cyst is not surgical.

    • Observation. Because the ganglion is not cancerous and may disappear in time, if you do not have symptoms, your doctor may recommend just waiting and watching to make sure that no unusual changes occur.
    • Immobilization. Activity often causes the ganglion to increase in size and also increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms and cause the ganglion to decrease in size. As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.
    • Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it.

This procedure is called an aspiration.

The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid can be withdrawn.

Aspiration frequently fails to eliminate the ganglion because the “root” or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not removed. In many cases, the ganglion cyst returns after an aspiration procedure.

Aspiration procedures are most frequently recommended for ganglions located on the top of the wrist.

Surgical Treatment

Your doctor may recommend surgery if your symptoms are not relieved by nonsurgical methods, or if the ganglion returns after aspiration. The procedure to remove a ganglion cyst is called an excision.

Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion. Even after excision, there is a small chance the ganglion will return.

Excision is typically an outpatient procedure and patients are able to go home after a period of observation in the recovery area. There may be some tenderness, discomfort, and swelling after surgery. Normal activities usually may be resumed 2 to 6 weeks after surgery.

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Ganglion Cysts

Ganglion cysts are fluid-filled sacs. They can occur at any joint in your body, but are most common around the wrist. Ganglion cysts may also appear on the feet.

Ganglion cysts form when the natural lubricating fluid leaks out of a joint or tendon, making a little sac (or cyst).

Symptoms of ganglion cysts

The main symptom of a ganglion cyst is a swelling in the area affected. They tend to be smooth and round and can vary in size. Some can be large and prominent, while others are so small that you can’t feel or see them. Sometimes they shrink or grow, and may even disappear altogether, only to reappear at a later date.

If a ganglion cyst puts pressure on a nerve, you may experience discomfort or altered movement.

Causes of ganglion cysts

It’s not usually known what causes the fluid to leak out of your joint or tendon, leading to the development of a ganglion cyst.

However, women are more likely to get ganglion cysts than men, and you are most likely to get them in your 20s to 40s. Sometimes, ganglion cysts form after an injury or after placing too much stress on a joint or tendon (for example, following repeated stress on the wrist in gymnasts). However, most people have not had an injury and the cause is unknown.

Diagnosis of ganglion cysts

Your GP can usually make a diagnosis just by feeling and looking at the lump, and asking questions about your symptoms. He or she might shine a small bright light through the lump, as this can help to confirm that the fluid inside is clear.

If necessary, your GP may ask to draw some fluid out of the lump into a needle. He or she will send the fluid to a laboratory for analysis to confirm that the lump is a ganglion. Sometimes, your GP may suggest referral for an X-ray or other test, such as an ultrasound or MRI, to rule out other conditions or to check for small ganglion cysts that aren’t visible.

Treatment of ganglion cysts

Ganglion cysts are harmless and aren’t cancerous. Many disappear on their own without any treatment, and often they don’t cause any trouble. Because of this, most people don’t need any specific treatment. Instead, your GP will just keep an eye on your cyst and wait to see if it disappears on its own over time.

Non-surgical treatments

If your ganglion cyst is painful or is affecting how you move your hand (or foot), you can have it drained to reduce the swelling. This is called aspiration. A needle is used to puncture the cyst, and the fluid is drained away. Aspiration is done under local anaesthesia, so the skin over the area will be numb but you will stay awake. Aspiration reduces the swelling, but it’s likely that your ganglion cyst will come back later.

Surgery

If you want to have your ganglion cyst removed and aspiration doesn’t help, your doctor may recommend surgery to remove it. However, there is still no guarantee that your ganglion cyst won’t return and you may need to pay for the surgery.

Surgery to remove a ganglion involves cutting the skin over where your ganglion is, and removing the ganglion from the joint or tendon lining. Afterwards, the cut will be closed with stitches and covered with a dressing.

Most ganglions are removed under local or regional anaesthesia as a day-case procedure. This means that the treatment area will be completely numb but you will stay awake. Local anaesthesia numbs the small area that is being operated on, while regional anaesthesia numbs the whole limb. You may be offered general anaesthesia for larger ganglions on the wrist or ankle. This means you will be asleep during the operation. Your surgeon will advise which type of anaesthesia is most suitable for you.

If the ganglion has been removed from your hand or wrist, your nurse may put your arm in a sling. He or she may also give you a splint or cast to support your arm or leg. Before you go home your nurse will give you some advice about caring for your healing wounds and a date for a follow-up appointment.

The area will feel sore, stiff and swollen for a few days after surgery. Complete recovery can take two to six weeks.

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