Wrist Ganglions

A ganglion refers to a small, benign, fluid-filled cyst that can form in the wrist. These cysts are painless and don’t disrupt daily activities; hence, treatment is usually unnecessary. However, various treatment options are available if they cause pain or interfere with movement.

Symptoms

The symptoms of wrist ganglions often vary based on the type. The dorsal wrist ganglion presents as a lump or mass on the back of the wrist. On the other hand, the bump in the volar wrist ganglion is found on the wrist crease under the thumb. The cyst may develop gradually or appear suddenly and can fluctuate in size from time to time.

The affected wrist can feel tender or ache, which may affect daily tasks. A volar wrist ganglion may press on the median or ulnar nerve, leading to sensory or movement difficulties. Occult dorsal wrist ganglions can be somewhat painful and tender when touched despite being smaller compared to other cysts.

Wrist ganglion symptoms are generally harmless and do not worsen over time. In addition, they will not become cancerous.

Causes

The exact cause of wrist ganglion is unknown, but certain factors may contribute to their development. These include previous wrist injuries and activities that put repetitive stress on the wrist, such as tennis or golf.

According to some theories, ganglion cysts form when connective tissue weakens or degenerates due to wear and tear. This creates a weak spot in the joint capsule, similar to how the inner tube of a damaged tire bulges out. The joint fluid may leak out through this weak spot and build up as an external cyst. This cyst gets bigger over time since it appears that the joint fluid flows from the wrist joint into the ganglion and not the opposite. Eventually, the cyst is filled with a transparent, sticky substance. The fluid is a mixture of substances often present in the joint.

Diagnosis

Our doctors at The Joint Pain Clinic will diagnose wrist ganglions by examining the hand and wrist and reviewing a history of the condition. This is usually enough to make a diagnosis. However, locating an occult dorsal wrist ganglion can be more challenging due to its miniature size.

Treatment and Management

We often treat and manage dorsal and volar wrist ganglions with nonsurgical or surgical methods. It is, however, important to thoroughly weigh the potential risks and advantages of any wrist ganglion treatment.

Nonsurgical options:

• Dorsal wrist ganglions

Dorsal wrist ganglions were formerly addressed by breaking them open without causing skin rupture. This was accomplished by applying strong pressure or using a mallet (or bible). Nonetheless, this kind of treatment is no longer employed because ganglions frequently return after it.

For wrist ganglions, observation is frequently enough treatment. Generally, ganglions are benign and do not worsen with time. Additionally, they typically don’t impact the nerves, tendons, or joint itself.

Up to 50% of wrist ganglions may eventually disappear on their own.

Another conservative treatment approach for dorsal wrist ganglions is a closed rupture with several needle punctures, which goes beyond observation. A needle is used to puncture the cyst wall, and numbing and anti-inflammatory medications are then delivered into the cyst. While this procedure can reduce symptoms and constrict the cyst, the ganglion will probably resurface.

• Volar wrist ganglions

The most popular nonsurgical method for treating volar wrist ganglions is observation.

Surgical options:

In cases where the cyst disrupts daily activity or causes severe pain, surgery may be an option. Additionally, it is advisable if the ganglion is exerting pressure on the wrist’s nerves, as this may result in issues with hand movement and sensation. The procedure is typically performed under regional anesthesia, numbing only the arm, but general anesthesia may also be used if necessary.

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