Ganglion Cyst - Wrist

What is it?

A ganglion cyst is a benign (noncancerous) mass usually on either the top or bottom of the wrist. This cyst may be small or may be up to 2 to 3 cm in size. The wall of the cyst is made of collagen and filled with a thick gelatinous fluid. Ganglions are not cancerous and do not become cancerous.

The exact cause of a ganglion cyst is unknown. A small number (perhaps 10%) are associated with a known traumatic event. Usually, there is no obvious cause. Ganglions are generally located on the top or bottom of the patient's wrist; however, ganglion cysts have been described on all the joints of the wrist and hand.

What are the symptoms?

Ganglion cysts are most common in women between 20 and 40 years old. However, many men also have ganglion cyst. The ganglion cysts have also been described in children.

Most patients notice a mass with swelling about the wrist. Frequently the mass is not painful, but may be of great concern to the patient. The patient worries about the cause of the mass and the appearance. If the ganglion cyst does bother the patient, it is usually either a dull ache or a sharp pain usually in the area of the ganglion cyst and increases with flexion or extension.

How is it evaluated?

The diagnosis of ganglion cyst can be made by history and physical examination. Ganglion cysts have a classic look and feel and are usually in a very specific location. X-rays may be ordered to evaluate the possibility that the cyst extends into the bone or to see possible evidence of ligamentous injuries. Both of these problems are relatively uncommon. For a patient with a painful wrist that clinically sounds like a ganglion cyst, but cannot be palpated, an MRI may be ordered to evaluate this further.

How is it treated?

Nonoperative

  1. Simple observation is appropriate for minimally symptomatic cyst. Some patients require reassurance only that this is not harmful and may be treated with observation only. Ganglion cysts do not cause progression to arthritis or cause ligamentous injury.
  2. Aspiration of the cyst may be recommended. This is a simple and safe procedure. If a clear thick gelatinous fluid is removed, it confirms the diagnosis. Approximately, 20 to 30% of the time an aspiration also cures the problem. More often, the cyst returns after aspiration.

Operative

Excision (removal) of a cyst may be recommended. Indications for cyst removal are pain, unsightly appearance, or to confirm the diagnosis. The surgery may be done as an outpatient with either general or regional anesthesia. The cyst is removed tracing it down to the wrist joint, which is the origin of the cyst. The cyst is then removed along with the part of the wrist capsule. The bones and ligaments around the cyst in the wrist are inspected, but usually no further treatment is required except for excision.

Postoperative

The surgeon will usually place the wrist in a bulky dressing that includes a splint. The patient's finger, thumb, and elbow are free to begin range of motion. The dressing must be kept clean and dry until the first postoperative visit some time between one and two weeks.

Will the cyst recur?

The exact percentage of recurrence after surgical excision is unknown. It is probably between 10 and 15%. If a cyst does recur, the appropriate treatment is similar to the primary cyst. Observation may be chosen. Repeat removal may also be chosen.