Ganglion Cyst
A ganglion cyst in a fluid filled bump that can occur at many locations throughout the hand or wrist. The most common locations include the back of the wrist, the palm side of the wrist, along the tendons that bend the fingers (volar retinacular cyst) or along the finger joint nearest the nail (mucous cyst).
Dorsal wrist ganglion cyst
The cause is often unknown, but can be due to underlying joint or tendon irritation, subtle injuries, or arthritis. The cyst acts like a balloon that fills up with thick, jelly-like fluid from a nearby joint or tendon.
Diagnosis
A ganglion cyst can often be diagnosed on physical exam, as they characteristically occur in predictable locations, are often round or oval, are oftentimes soft, and allow light to easily pass through them (trans-illuminate).
Some smaller ganglion cysts can only be seen on MRI. Ganglion cysts, which are soft and fluid filled, do not show up on x-rays, which primarily show bones and joints. Sometimes an MRI will be ordered to diagnose or explain pain along the back of the wrist. Activities requiring wrist “extension’, such as push-ups, yoga, or pushing yourself up from a seated position, can cause pain when the cyst is pinched in the back of the wrist.
Ganglion cyst on MRI. The red arrows outline a ganglion cyst on an MRI image of the wrist. Ganglion cysts appears white on MRI. Smaller ganglion cysts may only be seen on MRI, these will oftentimes cause pain when extending the wrist, such as with push-ups, yoga, or pushing up from a seated position.
Treatment
Ganglion cysts can be safely observed, especially if they are not causing any pain or limitations. They are not cancerous and do not spread. If they are causing pain, limiting function or are otherwise unacceptable, they can be treated via various methods depending on the location.
Non-surgical treatment
Observation
Splint to minimize discomfort
Massage
Aspiration
Cysts on the back side of the wrist can be aspirated (fluid drawn out from them with a needle). Unfortunately, if the stalk of the balloon still communicates with the joint, it can refill ~50% of the time. Aspiration is not usually offered if the cyst is on the palm side of the wrist and close to the radial artery
Surgical treatment
Wrist ganglion cysts can be dissected from surrounding tissues and safely removed in the operating room. While aspirating the fluid from a cyst is akin to pulling the top off of a weed, surgically removing a cyst is akin to pulling a weed out by its root. Recurrence rates are low, but can occur.
Volar Retinacular Cyst
Non-surgical treatment
Observation
Massage
Aspiration/rupturing with a needle
Surgical treatment
If a volar retinacular cyst recurs after an attempt at aspiration and is causing discomfort when holding things in the palm (like a pebble inside your shoe), they can be surgically removed with an acceptably low recurrence rate.
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.