Ganglion cysts are a common benign swelling that can occur around joints and tendons of the arms and legs, but are most often found on the wrist. They are fluid-filled sacs that form on or near joints or tendons, and can range in size from a pea to a golf ball.
While ganglion cysts are generally not harmful, they can cause pain, discomfort and limit mobility, so it's important to understand their causes, clinical signs, imaging, and treatment options.
What causes Ganglion Cysts and how are they diagnosed?
The exact cause of ganglion cysts is unknown, but they often arise from the tendons or joints around the wrist, as well as the trapeziometacarpal joint at the base of the thumb. They may develop due to repeated stress or injury to the joint or tendon, or due to degeneration of the joint or tendon over time.
The most common clinical sign of a ganglion cyst is a small bump or lump around the wrist or thumb that may feel firm or spongy to the touch. The lump may be painless or cause mild to moderate pain, especially when the joint is moved or pressure is applied to the area. The cyst may also cause a sensation of weakness or numbness in the hand or wrist. In some cases, the cyst may be visible under the skin, or it may be deep within the joint and only detectable through imaging.
If you suspect you have a ganglion cyst, the doctor may order imaging tests such as X-rays, ultrasound, or MRI to confirm the diagnosis and rule out other conditions. These tests can help determine the size, location, and composition of the cyst, as well as any damage or inflammation in the surrounding tissues. While ganglion cysts are generally benign, it's important to rule out other conditions that may have similar symptoms, such as an infection or tumour. Your doctor can also help determine the best treatment options based on the size, location, and severity of the cyst.
What are the non-surgical treatment options for Ganglion Cysts?
In many cases, ganglion cysts can be treated without surgery. Non-surgical treatment options include:
Observation: If the cyst is small and not causing any discomfort, your doctor may simply recommend monitoring it to see if it goes away on its own.
Immobilisation: Wearing a splint or brace can help immobilise the joint and reduce irritation of the cyst.
Aspiration: Your doctor may recommend aspiration, which involves using a needle to drain the fluid from the cyst. This is a simple, non-invasive procedure that can be done in the doctor's clinic with or without the use of an ultrasound.
In addition to medical treatment, there are steps you can take at home to manage the symptoms of a ganglion cyst. Resting the affected area and avoiding repetitive motions can help reduce irritation and inflammation. Over-the-counter pain medications such as Paracetamol or Ibuprofen can also help alleviate pain and discomfort.
It's important to note that while ganglion cysts are generally not harmful, there are rare cases where they can cause complications. For example, if the cyst presses on a nerve, it can cause numbness or weakness in the affected area. In some cases, the cyst may burst, leading to infection or inflammation.
Aspiration (drainage) of Ganglion Cysts of The Wrist
As we explore treatment options for ganglion cysts of the wrist, a key procedure to consider is aspiration, also known as drainage. This minimally invasive technique offers an alternative to surgical intervention.
Before the Procedure
Before aspiration, a detailed examination is necessary to confirm that the swelling is indeed a ganglion cyst. The area around the cyst is cleaned and sterilised. Local anaesthesia may be administered to minimise discomfort during the procedure.
During the Procedure
The doctor inserts a needle into the cyst under sterile conditions, often guided by ultrasound to ensure accuracy. The fluid is then drawn out from the cyst, which leads to a decrease in size and relief from symptoms.
After the Procedure
After aspiration, a bandage is applied, and patients are advised to keep the area dry and clean. Some minor pain and swelling may occur, which can typically be managed with over-the-counter analgesics.
Advantages
Non-surgical and minimally invasive
Quick recovery time
Can be performed in an outpatient setting
Potential Risks
Risk of cyst recurrence, as the cyst wall remains intact
Possible infection at the puncture site
Risk of damage to nearby nerves or blood vessels if not performed correctly
Follow-Up
Follow-up care involves monitoring the site for signs of infection or recurrence. Patients should report any new swelling or pain. In some cases, repeated aspiration or surgical removal may be considered if the cyst returns.
If non-surgical treatment options are not effective, or if the cyst is causing significant pain or limiting mobility, surgery may be necessary. Surgery involves removing the cyst and its stalk (the small, narrow attachment that connects the cyst to the joint or tendon). This is usually done under local anaesthesia, and recovery time is typically 2-3 weeks.
In conclusion, ganglion cysts on the wrist are a common condition that can be managed with proper medical assessment and treatment. While non-surgical methods may be effective, surgery may be necessary in some cases. If you suspect you have a ganglion cyst, contact ACTIVATE Musculoskeletal Clinic or book an appointment online and get your medical assessment and ultrasound scan and to confirm diagnosis, rule out other conditions and determine the best course of treatment. With the right care and management, most people with ganglion cysts can experience relief from their symptoms and return to their daily activities with minimal disruption.
About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.