Ganglion Cyst (Wrist)
Ganglion cysts are the most common soft tissue masses affecting the area of the hand and wrist: they are usually small in size (about 1-2cm) and affect the dorsal side of the hand more than the palmar side. They can affect people of any age.
Causes & Symptoms
Their exact cause is not totally understood but they are thought to be the result of repetitive microtrauma to the affected area, which in turn causes the lining of the joint (the synovium) to fill with excess fluid (synovial fluid rich of hyaluronic acid) produced by specialised cells which are present in that area (fibroblasts).
The fluid-filled sac which forms is the final result of this process and its content is clear and thick, which gives the cyst its peculiar feature of transillumination (light can pass through it). Sometimes a subtle instability of the bone of the wrist might cause irritation of the joint generating fluid that remains trapped in a cul de sac of the joint by a valve mechanism, creating a ganglion cyst which is under tension. When there is a local tension the cyst might become very uncomfortable and painful.
While the nature of ganglion cyst is completely benign (they are not cancerous), those affected often mention the aesthetic appearance. Patients may find that the cyst comes and goes, with its size varying, so that it is sometimes very painful and can interfere, at its largest size, with normal hand function. Nevertheless, their impact is somewhat variable: for some people it may become rather bothersome, for others it may be of little concern, if any.
Diagnosis is quite straightforward. An ultrasound scan can help diagnosis. In case of post-traumatic ganglion or clinical signs of wrist instability a x-ray or even an MRI scan might be recommended.
Ganglion Cyst (Wrist) Surgery
There are usually three general treatment approaches: observation, aspiration, and surgical removal. Some patients present to their treating consultant in order to simply confirm their condition and do not wish to proceed with any further treatment. Nonetheless, for those who wish to eliminate the cyst, it can either be aspirated or removed through minor surgery. Aspiration can be performed in a treatment room and involves sterilising the area, injecting local anaesthetic for pain control and aspirating the fluid inside the cyst with a small needle and a syringe under ultrasound guidance. Some anti-inflammatory medication (cortisone) can be injected afterwards to alleviate pain and often a period of rest with use of a splint can follow this treatment.
Alternatively, the cyst can be removed through a small incision or arthroscopically (key hole surgery) as a day-case surgery. While this procedure is slightly more invasive, it seems to lead to lower recurrence rates when compared to aspiration (21% versus 59%). Therefore, the decision of which treatment option is a shared one to be discussed between you and your consultant.