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Ganglion cysts are the most prevalent type of lump or mass found in the hand and wrist. Although non-cancerous and generally harmless, they frequently develop on the back of the wrist but can also appear in other areas. These fluid-filled sacs can change in size, appear suddenly, or even disappear without warning. While many ganglion cysts do not need medical intervention, treatment options are available if the cyst causes pain, impairs hand function, or creates cosmetic concerns.
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Description
A ganglion cyst forms from a joint, resembling a balloon attached to a narrow stalk. It originates in the tissues surrounding the joint, such as ligaments, tendon sheaths, or joint linings. The cyst is filled with a thick, slippery fluid that is similar to the natural fluid that lubricates joints. Ganglion cysts can develop in various locations within the hand and wrist, including:
- Both the back and palm side of the wrist
- The end joint of a finger
- The base of a finger
Their size can fluctuate, often increasing with activity and decreasing with rest.
The most common location of a ganglion cyst is on the back of the wrist.
Cause
The exact cause of ganglion cyst formation is still unclear. However, certain factors appear to increase the likelihood of developing these cysts:
- They most commonly occur in individuals aged 15 to 40
- Women are more frequently affected than men
- Repetitive stress on the wrist, as seen in athletes like gymnasts, may contribute to their development
Ganglion cysts that form near the end joint of a finger, known as mucous cysts, are often associated with arthritis in the finger joint. These cysts are more prevalent in women aged 40 to 70.
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Symptoms
Most ganglion cysts appear as a noticeable lump, though smaller ones can remain hidden beneath the skin (occult ganglions). While many ganglions only present as a visible mass without other symptoms, they can cause pain, tingling, or muscle weakness if they press against nearby nerves. Even if a cyst is painless, having a large one may still cause discomfort or self-consciousness due to its appearance.
Doctor Examination
Medical History and Physical Examination
During your first visit, the doctor will review your medical history and symptoms, asking questions such as:
- How long the cyst has been present
- Whether it changes in size
- If it causes pain
The doctor may press on the cyst to check for tenderness or discomfort. Since ganglions contain fluid, they are often translucent. Shining a light through the cyst can help confirm that it is fluid-filled rather than a solid mass.
Imaging Tests
- X-rays: While X-rays cannot detect ganglion cysts, they can help rule out other conditions like arthritis or bone tumors.
- MRI and Ultrasound: These scans provide detailed images of soft tissues, making them useful for locating hidden ganglions or distinguishing them from other growths. However, advanced imaging is usually unnecessary before treatment.
Treatment
Nonsurgical Treatment
The initial approach to managing a ganglion cyst is typically nonsurgical.
- Observation: If the cyst does not cause pain or other symptoms, the doctor may recommend monitoring it for any unusual changes, as ganglions are benign and can sometimes resolve on their own.
- Immobilization: Activities may cause the cyst to grow, increasing pressure on surrounding nerves and causing discomfort. Wearing a wrist brace or splint can help reduce the cyst’s size and alleviate symptoms. As the pain subsides, the doctor may suggest exercises to improve wrist strength and mobility.
- Aspiration: If the cyst causes significant pain or restricts activities, draining the fluid through a procedure called aspiration may be considered. The area is numbed, and the cyst is punctured to withdraw the fluid. However, aspiration often does not completely eliminate the cyst, as the root or connection to the joint remains. Thus, the cyst may return, especially if located on the back of the wrist. Aspiration near major blood vessels and nerves on the palm side can be more challenging.
Surgical Treatment
Surgery may be recommended if nonsurgical methods do not relieve symptoms or if the cyst reappears after aspiration. The procedure, known as excision, involves removing the cyst and its stalk, which may require partial removal of the joint capsule or tendon sheath to ensure complete removal. Despite surgery, there is still a small risk of the cyst returning.
Excision is typically an outpatient procedure, allowing patients to go home the same day after a brief recovery period. Post-surgery, some tenderness, swelling, and discomfort may occur. Most patients can resume normal activities within 2 to 6 weeks.
Outcomes
Ganglion cysts rarely cause permanent problems, and those that do not resolve on their own usually respond well to surgery. In rare instances where the cyst returns after excision, a follow-up surgery can be performed to remove it again. Most patients experience significant relief after the cyst is surgically removed.