Ganglion Cyst of the Wrist

Most of the masses that appear in the hand and wrist are benign.  One mass that is commonly seen in the wrist is a ganglion cyst.  A ganglion cyst is a fluid-filled sac filled with joint fluid.  A ganglion cyst may be located on the back or dorsum of the wrist or on the palmar side of the wrist. surrounding the wrist joint is the lining of the joint or capsule.  In the case of a ganglion cyst, a small weak spot or hernia occurs which allows joint fluid to escape and form a small cyst.  The cyst is connected to the wrist joint by a long tube-like stalk. a dorsal ganglion typically originates from the wrist near the scapholunate joint.  The palmar or volar ganglion typically originates from the radiocarpal joint or wrist joint.  A ganglion cyst may develop after repetitive flexion or use of the wrist which may weaken the capsule.  It also has been noted to develop after trauma to the wrist.

Ganglion cysts may be symptomatic or asymptomatic.  The cyst may be small and remained underneath the wrist tendons-noticeable only as a diffuse swelling of the wrist and some tenderness or tendinitis.  This is known as an occult ganglion.  Diagnosis of occult ganglion requires suspicion of its presence after exam and confirmation with an MRI.  In most cases the ganglion cyst has expanded to the surface and is easily visible as a firm cystic mass. the mass may get bigger and smaller with more intensive or less intensive wrist use.  The stalk functions as a partial one-way valve to allow joint fluid to pump into the cyst with wrist use. the ganglion cyst may be painful itself.  It usually caused the symptoms by displacing the tendons and other structures, causing irritation.

Treatment of the cyst may be conservative with observation only if it is small and asymptomatic.  Aspiration or draining the cyst is usually not recommended since the recurrence rate is 100% and there is risk of infection.  Hitting it with a bible or breaking it as was suggested for such “preachers nodes” is also not suggested since the recurrence rate is also very high and the trauma and scar tissue that results makes later excision difficult.  If conservative treatment does not work, the usual treatment is surgical excision of the ganglion.  At this surgery local standby or twilight anesthesia is used. An incision is made over top of the ganglion, the cyst is exposed and the surrounding tissues and tendons are pulled aside, exposing the stalk all the way down to the wrist capsule.  The abnormal section of capsule is removed together with the cyst and the capsule was repaired.  The skin is closed and a small dressing and splint are removed.  The skin sutures are removed at two weeks postop.  A wrist splint which allows finger motion is used for two to 6 weeks after surgery, depending on the amount of abnormal capsule.  The splint helps to reduce the rate of recurrence. risks with this surgery. risks with the surgery include anesthesia related risks, wound healing problems or infection as well as recurrence of the cyst.  Recurrences 3 to 5% in both national studies.  Ganglion cyst may occur less commonly at other joints in the hand as well. Treatment is similar.