A ganglion cyst or wrist ganglion is a small lump which appears in the wrist. It is often attached to a ligament. Some are not painful, but others restrict movement and are painful. Here we explain the symptoms, causes, and treatment of wrist ganglions.
Ganglion cyst symptoms
Wrist ganglions are more common in women with 70% occurring in people between the ages of 20-40.
- They appear around the wrist joint as a small lump or swelling.
- Some are painless, however, others cause wrist pain which can vary from mild to severe.
- Pain may be aggravated by moving your wrist or direct impact or trauma to the cyst itself.
- The pain may come and go, as might the swelling.
- An MRI scan is likely to confirm the diagnosis.
The size of the cyst and the severity of pain varies from person to person. Some wrist ganglions are not painful so can be left. Others can hinder movement and cause pain, so may require treatment.
What is a Wrist ganglion?
The ganglion itself is like a balloon that is attached to a ligament in the wrist, normally the scapholunate ligament (between the scaphoid and lunate bone) on the back of the wrist and one of the volar ligaments on the inside of the wrist. Ganglions can also occur at the base of the finger which can interfere with gripping things
The cause of a ganglion cyst is not known although damage to the joint has been suggested as well as a problem with the joint capsule or tendon sheath which causes the joint tissues to bulge out. It is seen in young patients as well as older patients with arthritis although it does tend to come on for no apparent reason. The ganglion can go up and down in size and interfere with the movement of the wrist causing pain.
If the cyst is not painful then no treatment is necessary. It can just be left. Or if it is going down in size then no treatment other than reassurance is needed. However, if it is painful or causes problems in a sport then a doctor may aspirate the cyst (suck out the fluid with a needle) using ultrasound imaging as guidance. There is a high chance of a ganglion cyst recurring up to 70%.
There is a high recurrence rate with an aspiration of up to 70% although when they do come back they are often smaller and do not cause as much trouble. When it is aspirated we are simply emptying the balloon. The balloon is still there which is why there is such a high recurrence rate. The vast majority of wrist ganglions will disappear on their own.
Injection of corticosteroid can give temporary relief and in more severe cases surgery is required to completely remove the cyst although it is possible in 30% of cases the ganglion will return.
Ganglion cyst surgery
Mr. Elliot Sorene MBBS FRCS (Tr Orth) EDHS Consultant Orthopaedic, Hand Upper Limb Surgeon talks to sportsinjuryclinic.net about surgery and other treatment options.
Surgery is sometimes considered if conservative treatment is not successful where the ganglion can be cut out using keyhole surgery. When it is surgically excised or cut out then the balloon is removed with its stalk that attaches the ligament but even once this is removed it can still recur.
References & further reading
- Couzens G, Daunt N, Crawford R et al. Positive magnetic resonance imaging findings in the asymptomatic wrist. ANZ J Surg 2014;84(7–8):528–32.