Finding a lump on your hand or wrist can be a frightening experience. But most of the time, these are harmless ganglion cysts that will often disappear in time.
Commonly, ganglion cysts grow on the top of the wrist (dorsal ganglions). But they can also be found on the underside of the wrist (between the thumb and your pulse point), at the end joint of a finger or at the base of a finger. A ganglion grows out of a joint, like a balloon on a stalk that rises out of the connective tissues between bones and muscles. Inside the balloon is a thick, slippery fluid similar to the fluid in your joints. Usually, the more active you are, the larger the lump becomes; when you rest, the lump decreases in size.
What Causes Ganglions
No one knows what triggers the formation of a ganglion. Women are more likely to be affected than men, and ganglions are common among gymnasts, who repeatedly apply stress to the wrist. Because the fluid-filled sac puts pressure on the nerves that pass through the joint, some ganglion cysts may be painful. Large ganglions, even if they are not painful, are unattractive. Smaller ganglions that remain hidden under the skin (occult ganglions) may be quite painful.
Examination & Diagnosis
Your doctor may ask you how long you’ve had the ganglion, whether it changes in size and if it is painful. He or she may apply pressure to see if there is any tenderness, or hold a penlight up to the cyst to see if the light shines through. You will probably need to get an X-ray, so that the doctor can rule out conditions such as arthritis or a bone tumor. Sometimes, an MRI or ultrasound is needed to find a ganglion cyst hidden under the skin.
In the past, these would often be treated at home by rupturing them with a large book (“the bible treatment”). Even today, many people have these cysts aspirated (injected with a needle, removing the fluid). Unfortunately, these methods are almost certain to result in recurrence; they may cause additional scar tissue to form that would make ultimate surgical resection more difficult. The best treatment option is for surgical resection; this can be done as an outpatient.
Ganglion cysts are the most common mass or lump in the hand. They are most common on the back of the wrist. These non-cancerous, fluid-filled cysts arise from the ligaments, joint linings, or tendon sheaths when they are irritated or inflamed. They may disappear or change size quickly.
Ganglion cysts do not require treatment. However, quite commonly they are painful, or may interfere with function; even if the patient does not like the appearance, Dr. Concannon can remove it surgically as an outpatient.