Ganglion (Cyst) of the Wrist

A wrist ganglion can appear on the A, back (dorsum) of the hand or B, on the underside (volar).

Ganglion cysts arise from the capsule of a joint or the sheath of a tendon. They can be found at different places on the wrist. A ganglion cyst that grows on the top of the wrist is called a dorsal ganglion. Others are found on the underside of the wrist between the thumb and your pulse point, at the end joint of a finger, or at the base of a finger. Most of the time, these are harmless and will often disappear in time.

Cause

A ganglion cyst contains a thick, clear, mucus-like fluid similar to the fluid found in the joint. No one knows what triggers the formation of a ganglion. Women are more likely to be affected than men. Ganglia are common among gymnasts, who repeatedly apply stress to the wrist.

Symptoms

Because the fluid-filled sac puts pressure on the nerves that pass through the joint, some ganglion cysts may be painful. Large ganglia, even if they are not painful, are unattractive. Smaller ganglions that remain hidden under the skin (occult ganglions) may be quite painful.

A ganglion grows out of a joint, like a balloon on a stalk. It rises out of the connective tissues between bones and muscles. Inside the balloon is a thick, slippery fluid similar to the fluid in your joints. Usually, the more active the wrist, the larger the cyst becomes. With rest, the lump generally decreases in size.

Treatment

Initial treatment is not surgical.

Observation: Because the ganglion is not cancerous and may disappear in time, just waiting and watching may be enough to make sure that no unusual changes occur.

Immobilization: Activity often causes the ganglion to increase in size. This is because activity increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms, letting the ganglion 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 "aspiration." The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid drains away.

Nonsurgical treatment leaves the outer shell and the stalk of the ganglion intact, so it may reform and reappear.

Surgery: After nonsurgical measures have failed, the ganglion cyst can be removed surgically. Surgery may include removing part of the involved joint capsule or tendon sheath. The cyst is usually removed through a small incision the length of the cyst. Although there is typically a lower chance of cyst recurrence with surgical removal, however this is not always a guarantee that the cyst will not grow again. There may be some tenderness, discomfort, and swelling after surgery. Normal activities usually may be resumed two to six weeks after ganglion cyst surgery.