GANGLION CYST - swelling in the wrist

Patients frequently present to the clinic with a lump at the wrist, with or without associated pain. These masses are usually round, smooth, and soft to firm with pressure.
The usual diagnosis would be a GANGLION CYST.

 

 

Ganglia cyst are among the most common cause of focal masses in the hand. They are thought to arise from the joint synovium or the sheaths of the tendons transversing the joint. The cause of the cysts remain unclear although it has been hypothesized that occupational trauma plays a part.

As described above, they usually do not cause pain, although when they get bigger, the cyst might press onto the structures around the wrist joint, such as an overlying nerve or tendon. They could also catch onto clothing or watch straps giving rise to discomfort. Lastly, they could just be a nuisance from a cosmetic point of view - in which case the patient usually request for excision.

Can you leave it alone?

Yes you can, and as I have explained, if they do not cause any pain, it really is a harmless swelling. In addition, if the swelling is small, there just might be a chance that the swelling would disappear.
However, some patients would insist that the lump be removed (for various reason - large swelling, pain, disfiguring, etc) in which case the options are:

Aspiration of the cyst.

This can be done as an office procedure. A local anaesthetic is usually administered around the lump and the lump aspirated with a large bore needle. Some practitioners would instil steroid into the remaining cavity to prevent recurrence. The success rate of this procedure is about 60%. (ie 1/3 of patients will have recurrence)

Surgical excision

The procedure of choice, in my opinion, as the success rate goes up to 90% (ie only 1 in 10 surgeries will have a recurrence). This can be done as a day procedure in the OT. Although some doctors can do it under local anaesthesia, the preferred method would be under general anaesthesia or a regional block at the minimum. The reason being that the root of the ganglion is usually deep seated and to get access to the deeper structures under local anaesthesia will cause much discomfort to the patient, not to mention unsettling to the operating surgeon.

 

  

   

Post surgery.

There might be some discomfort and swelling around the area operated. I usually close the skin with an absorbable suture so that no removal of the sutures need be done and it leaves a nicer scar.

Sometimes, with a larger lump, some ligaments of the wrist needs to be retracted and have to repaired. In this case, the patient will be required to use a resting wrist splint for a short period of time.