Monday, July 9, 2007

Ganglion Cyst of the Hand

Ganglion cysts are very common. The cyst are generally found on the top (dorsum) of the wrist (60-70%), the end joint of a finger (distal phalangeal joint), and at the base of a finger (palm-side). Ganglion cyst usually come up from nearby joint linings or tendon sheaths. These cysts can be painful, especially when they first appear and with constant or strenuous use of the hand or wrist. Ganglions often change in size and may disappear completely. These cyst are benign. There is no known specific cause for ganglions, but often there has been an injury before the appearance of the cyst. A ganglion cyst contains a thick, clear, mucus-like fluid similar to the fluid found in the joint. Women are more likely to be affected than men. Ganglia are common among gymnasts, who repeatedly apply stress to the wrist. Photo credit

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.

The diagnosis of a ganglion cyst is based on where the cyst is an d what it looks like. Your doctor may ask you how long you've had the ganglion, whether it changes in size, and whether it is painful. Pressure may be applied to identify any tenderness. A penlight may be held up to the cyst to see whether light shines through. X-rays may be taken to rule out other conditions, such as arthritis or a bone tumor. Sometimes, an MRI or ultrasound is needed to find a ganglion cyst that is not visible.

Treatment of ganglion cysts may consist of
  • Doing nothing. The cysts are benign and if yours is not painful, does not limit activity, and its appearance is acceptable to you, then there is no reason for further treatment. Just watch it for changes.
  • If it is painful, does limit activity, or you dislike its appearance, then treatment may include removing fluid from the cyst (putting a needle into the cyst and aspirating) and /or wearing a splint to keep the hand or wrist from moving.
  • If these non-surgical treatments fail, surgery to remove the cyst can be done. This surgery is performed on an outpatient basis. Anesthesia may be local, regional (where only the arm is numbed), or general. The goal of surgery is to remove the source of the cyst. This may require removal of a portion of the joint capsule or tendon sheath next to the ganglion. If the ganglion is removed from the wrist, a splint may be recommended following surgery for a few weeks. Some patients may feel tenderness, discomfort, and swelling at the site, but full activity can be resumed once comfort permits. While surgery offers the best success in removing ganglions, these cyst can and do return.
A Patient's Guide to Ganglion Cyst of the Wrist
Ganglion Cysts, Mayo Clinic
Ganglion Cysts, Indiana Hand Center

8 comments:

Femail doc said...

Does aspirating a ganglion cyst have a good success rate for permanent cure? Is that something I could do in my office? I probably wouldn't as I decided early on that I'd rather think about problems than stick them or cut them, but sending patients to a surgeon for ganglions always seems like overkill.

You are a great source of info for a PCP. Thanks.
Judy

rlbates said...

It depends on which source you read--50-70% after one to two aspirations. It is never a good idea to aspirate the volar ganglions that sit near the medial artery at the wrist. Click on the "aspirate" link for a good picture of the "procedure". If you do ever aspirate a ganglion, remember the fluid is very viscous so use an 18g needle (a little local to the skin with a 30g first). Always splint (one the patient can remove for showering) after aspiration for a few days to a week.

kate51982 said...

After a painful ganglion cyst has been aspirated, how soon should I expect relief from pain? Is it within hours? Days? Will I be feeling pain from the procedure for a couple days after?

rlbates said...

Kate, there should have been some relief immediately. It may take several hours to days for all the pain to go away. Check with your doctor again if it hasn't.

Anonymous said...

Dont get mad...... Please....But, I have been aspirating my Volar ganglion for about a year now (10x). It comes back every time and even bigger!!

I am a RN and dont do this in my garage. I know I shouldnt but it relieves the pain!

DONT DO AS I DO IF YOUR SMART!!!! (Infection of the bone, Radial nerve and artery damage)
I have been lucky. I do have to admit....it was fun though.

I am having it removed in a week by an ortho md. I hope it doesnt come back for everyones sake.

Cynthia said...

I had a Ganglion Cyst aspired from my wrist a month ago and I am in more pain now then I was before the procedure, is this normal? Might I possibly have an infection? The cyst never went away, should I get it aspired again or choose the surgery?

Anonymous said...

I had a ganglion for 6 years before realizing what it was- doctors had thought I had tendonitis. Once it was discovered, I had it aspirated, shot with cortizone, & then took celebrex for six months. My pain came back within just 3 or months, but again, we couldn't tell if it was a return of the cyst or if it was tendonitis. Going off the celebrex, my wrist suddenly ballooned up & there was our answer. The cyst had in fact come back. I went in for surgery & had it and all inflamed surrounding tissue removed. I'm 2.5 months out and feeling fantastic! Still getting the scar tissue loosened up for flexibility, but I have no pain. I'm a cellist, so I took all of this very seriously. I'm already back to playing cello & feel very confident about having chosen surgery. Just make sure you do a lot of question asking & research to find the best hand surgeon you can!

The Muse In Willits said...

I am also a cellist with a ganglion Cyst.
I have stayed off my instrument for 6 months . I have seen everyone under the sun and finally came up with this care..for the little bugger.
FIrst no movement in wrist.
Use a proper brace.. I use it in the night when I am sleeping and when I am working. I take it off during the day to rub the arm and such.
I went to acupuncture used electric on the needles.
I also went to a chiropractor who told me that most cellists who get this bend their neck and their wrist as a habit and this creates a problem
It is very imortant to pay attention to our bodies when we play.. I am coming back with ATF a muscular therapy and it is amazing.
I am not playing 15 mins a day ... and only very gently work...
It is seriousl
NEVER PLAY IN PAIN>
good luck