Joseph Yao, M.D.

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Ganglion cysts of the wrist

People often come to my office for evaluation of lumps located on their wrist. One of the most common lump is a ganglion cyst (GC). It is usually located on the thumb side of the wrist and may be found either on the top (dorsal) or bottom (palmar) aspect of the wrist.
     GC may arise after injury or strenuous use of the hand/wrist. Truck drivers use their hands to help pull themselves into the cabs of their trucks. They can also throw chains or ropes to tie down their loads. They may have to help load and unload their cargo. Any of these activities may injure the wrist and cause the appearance of a GC. GC may sometimes arise without any known injury or other cause.
     GCs typically arise from a defect in the joint capsule between two small bones of the wrist, the scaphoid and lunate. GCs can sometimes be very small and visible only when the wrist is bent upwards (extended) or downwards (flexed). Other times, GCs can be large and may increase in size over time. As its name implies, GC is a cyst, which is a hollow sac filled with a very thick, almost jelly-like fluid.
     Besides a visible lump, GCs may sometimes be painful. Pain is similar to wrist sprain pain. Wrist motion may be limited because of pain. Pain can be aggravated by forceful use of the hand/wrist for lifting, pushing, and pulling.
     A diagnosis of GC can often be made based upon the location of the lump and its characteristics. It is fixed at its base and immobile because it arises from the underlying joint. It can sometimes be deformed by manual pressure consistent with a fluid-filled lesion. It may be hard and feel like bone at other times. The diagnosis can be confirmed by inserting a needle into the lump and withdrawing cyst material. It is generally unnecessary to obtain X-rays or other tests such as MRI scans to diagnose GC.
     Treatment of GC includes three measures: Observation, aspiration and surgical excision. A fourth treatment informally called the “Bible treatment” consists of hitting the GC with a heavy book to rupture it. This form of treatment should be reserved only for GCs located on the top of the wrist. Hitting a GC on the bottom of the wrist risks injury to the overlying radial artery that runs between the GC and the skin.
     GCs may resolve without any treatment. Observation can include wearing a wrist splint with a rigid metal support and avoidance of strenuous activities. Surgical excision of GC located on the palmar side of the wrist must be done carefully to avoid damaging the radial artery. There is roughly a 40-50 percent chance of the GC recurring after observation, aspiration or surgical excision. Therre is no guarantee of permanently eliminating a GC regardless of treatment selected.
     Dr. Joseph Yao has undertaken extensive subspecialty training in joint replacement after completing an orthopedic surgery residency. He has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.