Ganglion Cyst

Ganglion Cyst of WristA ganglion cyst is a firm fluid-filled lump that can suddenly or gradually appear in various locations on the wrist or hand. The most common location is on the back of the wrist.

Ganglion cysts may also appear on the palm side of the wrist, or at the base of a finger.

These lumps may change in size from day to day, and may even disappear spontaneously. They can be quite painful, but sometimes even rather large cysts are completely painless. Many patients notice that a cyst will enlarge temporarily after periods of increased activity with the wrist or hand.

Sometimes a ganglion cyst develops as a result of an injury, but more often there is no known cause. The cyst feels firm, and often is mistaken for a "bone out of place." However, the cyst is actually a balloon-like structure, filled with fluid which arises from the joint or tendon sheath underneath the cyst.

Although ganglion cysts may be painful, they are usually harmless, even if untreated. They do not become cancerous, and most are located where they will not put pressure on any important nerves or blood vessels.

The doctor can usually diagnose a ganglion cyst by examining it, but sometimes an X-ray or sample of fluid from the cyst is needed to rule out other problems.

Once the diagnosis is made, some patients choose to leave a ganglion cyst untreated, if it is not painful or large enough to be unsightly.

Ganglion Cyst Aspiration

Treatment

If the cyst is painful, unsightly, or interfering with use of the hand, it can be treated with conservative or surgical means.

Conservative treatment usually involves removal of fluid from the cyst with a needle; while the needle is in place, a small amount of cortisone is injected into the cyst. This method may cause the cyst to shrink, to become painless, or even to disappear.

If the cyst remains after conservative treatment, or the patient and doctor decide that surgical treatment is needed, the cyst can be removed. For wrist ganglion cysts, surgical removal is done under regional block anesthesia (only the arm is numbed), as an outpatient. Even though the lump seems to be "right under the skin," the cyst has an attachment to the joint or tendon sheath underneath, and can be removed most reliably and safely in the operating room, with the best chance of permanent success.

A splint is generally worn for about 9 days after surgery, following which mild activity restriction is advised for another 10 days.