Ganglion Cyst on Wrist
Ganglion cysts on wrist are benign soft tissue growths that usually appear at the wrist, but can occur at virtually any joint. Under a microscope, a ganglion cyst consists of loosely oriented sheets of fibrous tissue with a few live cells to maintain and repair the fibrous tissue layers. They are filled with a gelatinous material that resembles synovial fluid, the fluid that lubricates joints, but is thicker and the components are in different proportions than in synovial fluid. Ganglion cysts are connected to joints by tortuous pedicles, or stalks.
Theories abound regarding how the ganglion cyst developed. Originally, they were thought to be simple herniations, or out-pouchings, of the lining of a joint, but as there is no synovial lining present within the cyst on microscopy, this is unlikely. They have also been postulated to be due to chronic inflammation, or irritation of the joint, but likewise there are none of the typical cellular inflammatory changes in a ganglion cyst, making this theory unlikely as well. Three of the most plausible theories are:
1) The capsular rent theory: A tear forms in the joint capsule, the fibrous coat of a joint sealing it off from outside tissue and keeping synovial fluid in the joint. This may be due to poor functioning of the joint leading to areas of weakness in the capsule. Some of the synovial fluid leaks out, eventually forming a cystic wall of fibrous tissue around itself.
2) The mucioid degeneration theory: Joint stress leads to degeneration of the connective tissue (soft tissue) near a joint causing fluid accumulation and formation of a fibrous cyst around the fluid.
3) The mucin secretion theory: Joint stress causes mucin to be produced by the live cells in the soft tissue which coalesce into pools of mucin which then forms a fibrous cystic wall around itself.
None of these theories completely explain all the elements and behaviors of a ganglion cyst.
So how does a ganglion cyst behave?
As stated above, a ganglion cyst (about 80-90% of them) forms around the wrist. 60-70% form on the back of the wrist, 13-20% form on the palmar side of the wrist. They are small, usually only 0.5-1 inch (1-2 cm) across. They feel firm and rubbery, and are not mobile i.e. do not move under the skin when manipulated, indicating that they are tethered (the tether being the stalk that attaches them to a joint). Sometimes they cause pain, sometimes not. They can cause aching that radiates up the arm with activity or manipulation of the cyst. On the palmar side of the wrist, they can cuase numbness or tingling due to compression of nerves. They may also decrease range of motion of the wrist due simply to their size, and may even decrease grip strength.
So what do I do if I have a ganglion cyst on wrist?
Medical science has debated this for hundreds of years. Usually that means that not one good treatment has been found.
In the 1700’s, treatments varied from dropping the family Bible (usually a heavy book) on the cyst to rupture it, to rubbing them with saliva first thing in the morning and binding them with a lead plate, and to rubbing them with a dead man’s hand. The current treatments include:
– Doing nothing as the majority of cysts will resolve within 2 years;
– Aspiration of the cyst fluid with a wide bore needle, which has a success rate of about 30-50%, sometimes because the fluid is too thick to be aspirated and sometimes because the cyst recurs after a short time;
– Aspiration with injection of a corticosteroid, which was based on the theory that ganglion cysts were the result of inflammation, now thought to be false.Indeed, recent studies have indicated that aspiration alone is about as successful as aspiration and steroid injection;
– Surgical excision, the current “gold standard,” involves excising the cyst, its pedicle and a cuff of the joint capsule to which it is attached. Reported recurrence rates of 1-5% have been given for this method, provided the tortuous duct and pedicle is completely excised. However, recent literature reviews have shown that these high success rates often included patients who were having repeat surgical excision, indicating that their previous surgery was not successful, so the actual recurrence rate after surgical excision is likely higher than 1-5%.
In short, no fool proof methods of treatment are available. What this means is that the decision is largely up to the patient. If the cyst is not particularly painful, just bothersome and unsightly, some patients may opt to do nothing and live with the cyst, adjusting their activities to minimize the inconvenience caused by the cyst. If the cyst is painful or the patient finds it cosmetically unacceptable, conservative therapy such as aspiration may be attempted. If the cyst then recurs, the patient may be referred to a hand surgeon for surgical excision, provided they accept the risk of wrist stiffness and discomfort, as well as a post-operative scar, as risks of this procedure.
Find a Doctor who specializes in Ganglion Cysts on Wrist:
2952 Stemmons Freeway
Dallas, TX 75247-6196
Phone: (214) 637-6282
- Gude, W, Morelli, V. Ganglion Cysts of the Wrist: Pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008 December; 1(3-4): 205-211.