Wrist Ganglions

what they are and how to treat them

A wrist ganglion is a fluid-filled swelling that can develop near a joint or tendon within the hand. They can appear on the hand as bumps under the skin and vary in size (some can be as small as a pea where others can be as big as a golf ball).

Wrist ganglion symptoms, treatment, and post-operative care

Symptoms of wrist ganglions

Wrist ganglions will appear as a lump under the skin. Made up of synovial fluid, they will feel like jelly when prodded or touched.

These ganglion cysts are primarily found on the back of the wrist, hands, and fingers and at the base of the thumb.

Unfortunately, the condition can affect anyone, and the symptoms experienced will vary from patient to patient.

What we do find is that quite often, these cysts are not painful, but rather tense and uncomfortable.

At The Manchester Hand Surgeon, our team will examine your hands and the cysts in-depth. If we find they aren’t causing any pain or discomfort, we will advise to leave them alone for a set period, as often cysts can disappear without treatment. (However, we are aware that this can take longer and may not be suitable for everyone).

How do wrist ganglions form?

Ganglion cysts appear when the synovial fluid surrounding a joint or tendon escapes (leaks out), and it collects and forms into a sac (cyst).

Related to ganglion cysts are mucous cysts. This type of cyst is found primarily on the fingers and will also appear as a small lump.

Some might refer to ganglion cysts as “Bible Bumps.” This is an old-fashioned term for lumps appearing on the back of the hand, with the outdated treatment of such lumps to be to strike them with a Bible (or large book) causing the cyst to burst beneath the skin!

Fortunately, this treatment is no longer carried out, nor is it a course of treatment we would recommend at The Manchester Hand Surgeon!

Our treatments are much safer, cause less pain, and remove the problem much more effectively.

Wrist Ganglions – The Cause

Unfortunately, there is no definitive cause for why wrist ganglions form.

They can be related to changes in the lining of your joints; however, they are not associated with arthritis.

The workings of the hand are incredibly complex and intricate, and it can take only a tiny perforation in the synovial membrane for the fluid inside to start and escape and build up over time.

If we think of it like a tube of toothpaste, for all the toothpaste inside the tube is thick, with everyday pressure and use a small amount can squeeze out and will not automatically go back in.

The fluid in your wrist joint is the same. Once an opening is there, every time you move your wrist, a small amount of liquid can seep out and build and form into a separate sac.

The liquid is difficult to disperse due to the proteins contained in the fluid; water may well be drawn out; however, this will leave the remainder of the fluid-like jelly, hence a squashable lump formed on the back of your wrist or hand.

Treatment

Treatment can and does vary from patient to patient, and at The Manchester Hand Surgeon, we take care in tailoring your treatment plan to you and your condition.

We will carry out several tests and thorough assessments, providing you with options on what we believe to be most suitable for you.

Treatments at The Manchester Hand Surgeon can include:

Over the counter anti-inflammatory medications

These often work in the early stages of a cyst forming, and we would recommend aspirin or ibuprofen to help reduce swelling and ease any discomfort.

Custom Splints

Sometimes we will provide a custom splint to help support the joints further and to help prevent ganglions from forming or, indeed, reappearing. (Splints will be necessary after surgery to help the hand recover and to ensure the cysts do not reappear).

Draining the cyst

It may be possible to drain the fluid from the cyst using a needle or syringe. Also known as Aspiration, draining the cyst will depend on where it is located and whether it is a new cyst or a returning ganglion.

Using a needle or syringe, our team will look to remove as much of the contents of the cyst as is possible; however, it is unlikely the cyst will be 100% removed and cleared of fluid.

To help cortisone (steroid) injections can help prevent the ganglion from returning or indeed growing, however, this again is not 100% guaranteed, and we find that this course of treatment is much more effective if the cyst comes from a tendon rather than a joint.

This course of treatment is the most common, as it is much more straightforward, painless, and is a day procedure carried out within the clinic.

Our surgical team will talk you through this process in much more detail during your initial assessment and suitability for the treatment.

Removing the cyst entirely – Surgery

Surgery involves cutting and removing the cyst entirely from your wrist.

There are two types of wrist ganglion surgery offered at The Manchester Hand Surgeon:

Open Surgery – Open surgery involves making an incision (approximately 2 inches) over the site of the affected joint or tendon. The cyst will then be cut and removed from the hand.

Arthroscopic surgery – this is a form of keyhole surgery, where we make much smaller incisions into your wrist, and use a camera to look closer into the joint. Using the camera as a guide, we will then cut and remove the cyst altogether.

Both surgeries will require a local or general anaesthetic, depending on the patient and your preference, and we will discuss which one is best for your treatment, with our nurses and consultants on hand at all times to reassure you and answer any of your questions.

Surgery will typically take around 20 minutes, and we will stitch and bandage the area in question immediately after the procedure, providing your hand and wrist with full support.
In the case of wrist ganglion cysts, surgery is the most effective option at reducing the risk of them returning.

Aftercare

After surgery, you will have stitches and bandages to protect the wrist and hand. Your hand and the area in question must be kept clean at all times, reducing the risk of infection and helping to keep it safe from accidental knocks and bumps.

We will prescribe painkillers to help relieve any pain, and a sling may also be worn for the first few days to help rest the wrist and again protect the hand from knocks. The sling can also help reduce any swelling or discomfort experienced immediately after surgery.

We will recommend physiotherapy for a period after treatment, and it is essential to move your fingers regularly to help keep joints flexible.

Some patients do experience some bruising and swelling after treatment, and this is completely normal and should fade quickly. Ice and heat packs, as well as over the counter painkillers, will help to alleviate symptoms.

Temporary stiffness may also be a factor, and again with regular movement and carrying out the exercises prescribed by our hand therapists; this will fade.

Driving – we recommend returning to driving when it feels safe to do so, and we would always recommend checking your insurance policies for their recommendations on driving after surgery.

Returning to work

you may require 1-2 days off work after initial treatment, however after this, your hand should be functioning as normal, and depending on your job role, your regular daily activities can resume.

We will work with you on your treatment plan as well as aftercare package, ensuring you receive the best possible outcome and care.

To make your initial appointment and for pre-assessments to check your suitability for treatment, call our team today

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