A ganglion cyst of the dorsal wrist is a mass that can develop in various locations on the hand, most commonly on the back or the upper side of the wrist (dorsal wrist). Ganglion cysts are the most common form of growth on the hand. These cysts are most often harmless and are not cancerous masses. In fact, 95% of growths on the hand are discovered to be benign tumors, and 60% of this number is made up of ganglion cysts.
These cysts are filled with fluids, and most often, they appear and disappear very quickly. As a result, the majority of these ganglion cysts do not require treatment unless the cyst is painful, alters function of the wrist or hand, or has a deformed appearance. In this case, treatment is not necessary but it is available in several ways.
The ganglion cyst rises through a joint, growing out of the tissues that surround the joint, like ligaments, tendon sheaths and the joint linings. Inside the cyst is a viscous fluid, similar to that of the fluid that lubricates the joints.
Causes of Ganglion Cyst
Ganglion cysts are most common in people between the ages of 15 and 40 years old, with women being at high risk than men. However the direct trigger of ganglion cyst growth is not known. There is also a higher risk of this growth in athletes such as gymnasts, whose wrists are regularly subjected to a fair amount of stress.
Symptoms of Ganglion Cyst
When a ganglion cyst is present, the skin above the cyst looks unchanged, despite the mass growing underneath the skin. The mass however is compressible and movable.
The main symptom of a dorsal wrist ganglion cyst is the appearance of a growth on the back of a hand. Most of the time the cyst is visible, but there are occasions where the cyst is smaller and can remain hidden under the skin. In the majority of cases, ganglion cysts produce no other symptoms, but the following are possible results of the growth:
- Pain
- Tingling in the hand
- Muscle weakness
- When the cyst grows, it can sometimes put pressure on the nerves that run through a joint, and cause the issues mentioned above.
- The only other concern as far as the symptoms is the appearance. Often people find the appearance an issue and they may decide to get it removed.
Diagnosis of Ganglion Cyst
When a doctor is first consulting a patient about the growth, he or she may ask questions about medical history, symptoms, how long the ganglion cyst has been present and whether there have been changes in size, and whether the patient has experienced any pain in relation to this growth.
To confirm diagnosis, the doctor will often shine a light up to the cyst to look for translucency, since a ganglion cyst is filled with fluid and when present, will fulfil this quality.
The doctor may also suggest an X-ray. The purpose of this would not be confirm the presence of a cyst, as the X-ray works to show clear pictures of dense structures; mostly bone. This route would be taken to explore whether the problem is caused by something other than a cyst, such as arthritis or a bone tumor.
Following the initial examination, a doctor may also refer a patient for an MRI or ultrasound. This type of test can better examine soft tissue, in this case a ganglion. In addition, the MRI or ultrasound would be necessary to find an occult ganglion, and again, to look for possible tumors.
In addition to this, in the initial examination may involve an Allen test, in the case that the growth is located near the radial artery. This test involves making the patient elevate their hand and then make a fist for no less than 30 seconds. During this, pressure is applied to the ulnar and the radial arteries.
Treatment for Ganglion Cyst of the Dorsal Wrist
In most cases, the route to take with treatment is nonsurgical, and can be done in one of the following ways:
Observation: Since the ganglion cyst is non-cancerous and may disappear in its own time, if there are no symptoms, the doctor may recommend just waiting and observing the cyst to ensure no abnormalities occur
Immobilization: When the joint is used excessively around the area of the ganglion, it can often increase in size and creates greater pressure on nerves, which makes the cyst more painful. It is advisable to wear a wrist brace or splint to help relieve symptoms and allow the ganglion to decrease in size. Over time, the pain should dissipate, and as it does so, a doctor may give advice on exercises to strengthen the wrist again and increase function level
Aspiration: If the ganglion cyst is causing a significant level of pain and or limits activity significantly, it may be advisable to drain the fluid from it. This procedure is called aspiration. The procedure involves numbing the area around the cyst ad puncturing the ganglion with a needle to withdraw fluid. However, this procedure is unlikely to fully remove the cyst, as the root or connection to the joint is not fully removed this way. Frequently, following an aspiration procedure, a ganglion cyst will return. In addition, this procedure is not recommended for cysts located on top of the wrist.
Surgical Treatment for Ganglion Cyst of the Dorsal Wrist
A doctor may suggest surgery if the prior treatments have not proved successful or if the problem is worsening or reoccurring.The procedure to remove a ganglion cyst is called an excision, which involves fully removing the cyst and with it, removing part of the joint that the cyst is attached to. This procedure however does not fully guarantee that a cyst will not return after a time. This procedure is mostly done through outpatient care and after a period of recovery time, a patient can be dismissed. Surgery can leave some tenderness, swelling and discomfort, which means that full use and recovery of the wrist may not resume until a month after the procedure.
Diagnosis and Treatment
If you are experiencing pain in or around the hand and wrist joints or you have noticed abnormal masses, contact your doctor to have an examination immediately and determine the best treatment option for your case.
If you are ready to choose a team of hand, wrist and elbow orthopedic and sports medicine specialists that offer state-of-the-art treatment and highly personalized care, contact the OSMI office or call 817-529-1900 today!
