Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid.

Ganglion cysts of the wrist. The ganglion cyst is one of the most common masses or bumps that appear at the wrist. The majority are on the dorsal, or also known as the back side of the wrist, and they’re usually visible when the wrist is bent. They can occur on the other side of the wrist as well. The cyst arises out of the joint, like a balloon on a stalk. And although these cysts can feel hard like bone, they actually contain a very thick, gelatinous, joint fluid, and it’s under pressure. They can appear quickly. They can fluctuate in size and they can disappear completely, but they may also recur. Most are not very symptomatic.

What’s the cause of a ganglion cyst? The exact cause remains unclear. Most of these occur in younger patients, especially women and especially with very mobile or flexible joints. They can, however, occur in both men and women and in all ages. Most ganglions are not caused by any specific trauma or injury, although a traumatic event to the wrist can lead to the appearance of the ganglion cyst.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

Local Practitioners: Orthopaedic Surgeon

For most patients, the treatment simply involves reassurance. Pain associated with a ganglion cyst is often intermittent, mild, and tolerable. Causing pain to the wrist with specific activities does not change the prognosis or the pathology, and causing pain of the ganglion cyst does not lead to any long-term damage or any other issues to the wrist itself. For many patients, the pain associated cyst is not always present and commonly subsides over time, even though the cyst can actually remain.

Temporarily, the patient can use a wrist brace to help alleviate some of the flare ups. Anti-inflammatories or Tylenol may be of some benefit to decrease the pain. Although the aspiration of the cyst may decrease the visible size of the cyst, it rarely resolves the situation on a permanent basis. Patients who are unable to cope with the symptoms or who failed to completely become asymptomatic, then surgery could be considered. This usually involves an excision of a portion of the dorsal wrist capsule to prevent recurrence. It’s usually done in an ambulatory setting under local anaesthetic, just like going to the dentist. Unfortunately, many patients will still experience some stiffness

Recurrence rate following surgical excision of the cyst, as well as the surrounding capsule, is usually quite low, but recurrence is approximately 10%. Unfortunately, not all patients become asymptomatic following surgical excision of the cyst, and although the cyst is no longer visible, persistent discomfort with the push-up position may be present. Persistent issues may be due to deeper problems within the wrist.    Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise are also optimal for overall health.   Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC