Most of the masses that appear in the hand and wrist are benign. One such mass that is commonly seen in the wrist is a ganglion cyst. A ganglion cyst is a fluid-filled sac filled with joint fluid. It may be located on the back (dorsum) of the wrist or on the palmar (lower) side of the wrist.
These cysts develop in relation to the lining of the wrist joint. Sometimes, a small weak spot or hernia develops in this lining. The weak spot then allows joint fluid to escape and form a small cyst.
The cyst is connected to the wrist joint by a long tube-like stalk, and is labeled according to its location:
A ganglion cyst may develop after repetitive flexion or use of the wrist, as the repeated activity may weaken the joint lining (also referred to as the joint capsule). It also has been noted to develop after trauma to the wrist.
Ganglion cysts may be symptomatic or asymptomatic, depending on the nature of each cyst.
Treatment of the cyst may be conservative (i.e. with lifestyle changes and observation only) if it is small and asymptomatic. Aspiration or draining the cyst is usually not recommended in these cases, since the recurrence rate is 100% and there is a risk of infection. Hitting it with a bible or breaking it (as was suggested for such “preachers nodes”) is also not suggested; the recurrence rate is very high, and the trauma and scar tissue that results makes later excision difficult.
If conservative treatment does not work (or if the cyst is too large and causes too many symptoms to attempt conservative treatment), the next step in care is surgical excision of the ganglion. During this surgery, local standby or twilight anesthesia is used.
Risks with this surgery. include anesthesia-related risks, wound healing problems or infection, and possible recurrence of the cyst (which occurs in 3 to 5% of cases involved in national studies).
Note that a ganglion cyst may occur less commonly at other joints in the hand as well. Treatment is similar.