When we see a patient in their 30s with an unexplained lump on their wrist, one diagnosis initially comes to mind: ganglion cyst. And while a lump tends to make us think of cancer, the good news is a ganglion cyst is benign. It’s a non-cancerous lump that usually appears around the wrist joint but can also show up on the ankles or feet. Ganglion cysts often go away on their own, but your orthopaedist may need to jump in with surgical or non-surgical treatment if that lump becomes a problem.
What Is a Ganglion Cyst?
The American Academy of Orthopaedic Surgeons compares a ganglion cyst to a balloon on a stalk. It’s a fluid-filled lump that grows out of the tissues that surround your wrist, ankle or finger joint, including ligaments, tendon sheaths and joint linings. The cyst is filled with jelly-like synovial fluid, the same fluid that lubricates your joints. According to a 1993 study, 88 percent of ganglion cysts appear in the hand, while 11 percent occur in the ankle or foot. The most common location is the back of the wrist. We also see small ganglion cysts (called mucous cysts) at the end joint of the finger.
What Causes Ganglion Cysts?
The medical community isn’t entirely sure what causes ganglion cysts, but we can identify some risk factors. One theory is that they occur in spots where the tissue has been weakened by injury, arthritis or other causes since the cysts happen near tendons and joints that get a lot of wear and tear. We also know that ganglion cysts are most common in young people between 15 and 40 who tend to be more active, and they’re far more common in women than in men. One study showing frequent ganglion cysts in gymnasts supports the idea that activity and pressure on the joints is a contributing factor. Past joint or tendon injury has been identified as a risk factor, and there is also a connection with arthritis of the joints. Mucous cysts on the fingers are associated with arthritis in the finger joint and are more common in women between 40 and 70, according to the AAOS.
What Are The Symptoms of Ganglion Cysts?
The main symptom of a ganglion cyst is a visible lump, with or without pain. If a patient experiences pain connected with a ganglion cyst, it’s usually because the cyst is pressing on a nerve. The cyst can also cause tingling and muscle weakness.
How Does My Doctor Diagnose a Ganglion Cyst?
We can usually get a sense of what’s going on by touching the lump and looking at it with a light. However, we’ll usually do an ultrasound and in some cases an MRI to rule out a tumor and confirm our diagnosis.
What Is the Best Treatment for a Ganglion Cyst?
There are several paths for dealing with a ganglion cyst, from a wait and see approach to surgical excision.
- Observation: Many ganglion cysts go away on their own without medical intervention. So when we diagnose a ganglion cyst, we generally want to watch it to let it to shrink on its own. We may recommend immobilizing the joint since activity appears to correlate with ganglion cysts getting larger. In some cases, we’ll recommend a brace or splint to keep you from moving the affected joint. Gentle massage can also reduce discomfort and may help the cyst to shrink faster.
- Aspiration: If the cyst is painful or is limiting your movement, we may recommend draining the fluid from the cyst (called aspiration). This procedure usually works best for cysts at the top of the wrist, according to AAOS. However, cysts may return after aspiration, so sometimes surgery is needed.
- Surgery: if the cyst causes pain, limits movement or returns after an aspiration, your doctor may recommend surgical removal of the cyst along with the tissue that acts as the “root” of the ganglion. This increases the likelihood that the cyst won’t grow back. It’s usually an outpatient procedure and patients can return to normal activity after four to six weeks. Arthroscopic removal can help with a quicker recovery. We always try to avoid surgery, since the cyst will not cause damage to the wrist joint.
Can Physical Therapy Help After Removal of a Ganglion Cyst?
Physical therapy following the excision of a ganglion cyst can help speed recovery time and help you get back to your regular activities faster. Here are some of the ways your physical therapist can help you regain function in your hand:
- Passive range of motion exercise with your physical therapist
- Active range of motion exercises
- Strengthening exercises
- Finger extension exercises
- Grip exercises using a ball
Diagnosing and Treating Ganglion Cysts at Countryside Orthopaedics
If you’ve ever had an injury to your hand or wrist, you know how limiting it can be. Our hands are vital to our movements in the world, and pain, discomfort or a visible lump can slow us down and cause unneeded stress in our lives. If you have a ganglion cyst, we’ll help you decide which course of treatment is best for you and move forward with expert care. Our practice includes skilled orthopaedic surgeons, including a foot/ankle specialist and a hand specialist, several hand therapists and a top-notch physical therapy team. Having professionals for every avenue and phase of treatment in a single practice allows us to get you back in the game with whatever approach you choose.