A ganglion is a small, harmless cyst, or
sac of fluid, that sometimes develops in the wrist. Surgeons don't know exactly what causes ganglions, but a ganglion that isn't painful and doesn't interfere with activity and can often be left untreated without harm to the patient. However, treatment options are available for painful ganglions or ones that cause problems.
Wrist ganglions are attached to the joint either on the back of the hand, which is called a dorsal wrist ganglion, or a volar wrist ganglion typically appearing on the palm side of the wrist in the wrist crease just below the thumb.
A patient with a dorsal wrist ganglion may feel a bump or mass on the back of the wrist. With a volar wrist ganglion, the bump is felt on the wrist crease below the thumb. The mass may appear suddenly, or it may develop over time. The ganglion may occasionally increase or decrease in size.
The wrist may ache or feel tender. The ganglion may also interfere with activities. A volar wrist ganglion may compress the median or ulnar nerve, causing trouble with sensation and movement. An occult dorsal wrist ganglion may be quite painful and tender, even though it is smaller than other ganglions. Typically the symptoms from a ganglion are not harmful and generally do not grow worse. These cysts will not turn into cancer.
Observation is often sufficient treatment for wrist ganglions. Ganglions typically are harmless and usually do not grow worse overtime. Nor do they usually cause damage to the tendons, nerves, or the joint as a whole. As many as 50% of wrist ganglions may eventually go away by themselves. Beyond observation, closed rupture with multiple needle punctures is another nonsurgical treatment option for dorsal wrist ganglions. In this procedure, the cyst wall is punctured with a needle, and anti-inflammatory and numbing drugs are injected into the cyst. This treatment can shrink the cyst and alleviate symptoms. However, the ganglion is likely to re-appear. Volar wrist ganglion observation is the most common nonsurgical treatment for volar wrist ganglions.
Surgery is recommended when the patient feels significant pain or when the cyst interferes with activity. It is also recommended if the ganglion is compressing nerves in the wrist, since this can cause problems with movement and feeling in the hand.
Anti-inflammatory medication can be prescribed in order to decrease pain associated with activities.
An aspiration can be performed to remove the fluid from the cyst and decompress it. This requires placing a needle into the cyst, which can be performed in an outpatient setting. Aspiration is a very simple procedure, but recurrence of the cyst is common. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available.
Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath called ganglion removal.