A ganglion on the wrist (overleg) manifests itself in the form of swelling, which usually occurs on the dorsal side of the hand or wrist; it appears in the area of a joint capsule or tendon sheath and is also referred to as a synovial cyst.
It is a benign, liquid-filled, capsule-like shell.
Wrist cysts are not carcinogenic and do not spread, but their size can increase.
Synovial cysts usually occur on the back of the wrist, rarely found between the palm and wrist.
The cyst feels like a smooth, soft lump under the skin.
It consists of a viscous, gelatinous fluid, the synovia, which surrounds all joints and tendons as a lubricant to reduce friction during movement.
Cysts can develop anywhere in the body near the joints, but most often they occur on the wrist, hands and fingers.
In left-handers, the left wrist is more affected, in right-handers the right.
Wrist cysts occur predominantly in children and adolescents.
If the cyst does not cause pain or discomfort, it does not need to be treated and sometimes it regresses on its own.
What kind of fluid is the wrist cyst filled with?
It is the same fluid found in the joints or tendon sheaths. It can acquire a gelatinous substance over time.
Are synovial cysts on the wrist dangerous?
Synovial cysts are benign. In some cases, the cyst regresses spontaneously and does not require therapy.
A cyst is harmless, but can cause mild pain, especially if it is located near a nerve.
Causes of synovial cysts or ganglia
The cause of a synovial cyst has not yet been clarified; there are some explanations:
- The body reacts to injury, trauma and overload by forming an internal ‘bubble’.
- Smaller tears in the tendon membrane or joint capsule lead to a leakage of the fluid.
The reasons for the development of cysts are unclear, but are related to the aging or injury of joints and tendons. The cysts develop when the membrane surrounding a joint or tendon is damaged, causing synovial fluid to accumulate and form a bump under the skin.
Wrist ganglia occur primarily in people who frequently perform repetitive movements, such as guitarists or bodybuilders.
The patient often suffers from inflammation of the flexor tendons or extensor tendons of the fingers, and then, over time, develops a cyst on the wrist or hand.
Frequent use of the PC mouse does not cause cysts, especially if a convenient mousepad is used.
Symptoms of synovial cysts or ganglia
Typical symptoms of a cyst on the wrist:
- Obvious swelling or lumps on the wrist, smaller than a coin.
- The knot can change its size and just as well completely regress.
- The knot is usually movable and not hard.
- In some cases, the lump hurts, especially if it sits at the base of the finger.
- The pain increases when the nearby joints are moved.
- The affected tendon may cause a feeling of muscle weakness.
- The back of the wrist and wrist are most commonly affected.
Other typical sites for a synovial cyst include the hollow of the knee (Baker’s cyst), ankle, foot, palm, and fingers.
Can synovial cysts on the wrist disappear?
About 30-50% of ganglion cysts regress on their own without medical treatment.
If the cysts cause pain, they can limit mobility, cause numbness or tingling; in this case, a doctor should be consulted.
Diagnosis of synovial cysts or ganglia
Ganglion cysts can be diagnosed with the help of various examinations, including:
- Medical history
- physical examination,
- ultrasound to detect hidden cysts,
- Puncture (with the help of a thin needle, fluid is taken, which is subsequently examined in the laboratory).
Can the knot also be of a different nature?
Yes, it is important to have the lump thoroughly examined by a doctor to make sure it is a harmless synovial cyst.
Most protrusions that form on the wrist and hand are synovial cysts or ganglia (also known as overlegs), but there are other diseases that require other treatment. Fatty tissue tumors (lipomas) or giant cell tumors (osteoclastomas), infections, bone spurs and other diseases can also cause outgrowths on the wrist.
It is important to control the consistency of the cyst; if it is solid, it cannot be a synovial cyst, so it is necessary to find out what it is.
How is a wrist ganglion treated?
Modern medicine has made great progress, earlier a wrist ganglion with a Bible was burst so that the fluid could leak, or the protrusion was pushed back into the wrist.
There are various medical methods to remove the cyst and its contents.
Immobilization of the joint
Since synovial cysts can be caused by repeated joint loads, doctors usually advise immobilization of the joint so that the cyst can reduce its volume.
A wrist brace or hand splint can have a big effect in some cases.
Puncture of the wrist ganglion
If the cyst does not shrink due to immobilization, doctors usually advise draining the fluid.
Depending on the viscosity, the doctor may first inject an enzyme into the cyst to dilute the fluid.
After that, the cyst is emptied with the help of a needle.
Some doctors then inject cortisone into the cyst cavity to reduce the risk of recurrence.
In the past, ointments (for example, arnica ointment), heat therapy and various packs were used as home remedies.
This is rather refrained from today, as the effectiveness of these natural remedies has not yet been proven.
How to remove a cyst on the wrist?
There are several treatment options.
The orthopedist can insert a needle into the cyst and suck out the fluid, in some cases this is an effective therapy.
However, the gelatinous liquid cannot always be removed with a needle. In addition, the cyst shell remains in the wrist, and in 50% of cases the cyst forms again.
Physical therapy can help relieve symptoms, especially ultrasound therapy, which can also be done in water, but it doesn’t solve the problem.
A definitive solution is to remove the cyst as part of a surgical procedure.
During surgery, the wrist ganglion is removed as a whole, both the fluid and the outer shell.
This measure is usually effective, but with a small percentage, even here, the cyst returns over time.
There are two surgical methods used to remove a wrist ganglion:
- Open surgical procedure: The surgeon cuts the skin above the affected tendon or joint.
- Arthroscopy: A minimally invasive surgical procedure with smaller skin incisions and a tiny camera (arthroscope) that gives the surgeon insight into the joint.
With the help of the arthroscope, the instruments for removing the cyst are inserted through the incisions in the skin.
Both procedures can be performed under local or regionalanesthesia; the choice of anesthesia depends on the location of the cyst and the patient’s condition.
Open or arthroscopic surgical procedure, what is preferable for a wrist cyst?
Both techniques are equally effective in terms of cyst removal and relapse rate.
The minimally invasive procedure causes less postoperative pain, even if the waiting times are often longer.
The relapse rate after this procedure is about 30-40%.
The open surgical procedure leaves a small scar on the wrist, which fades more and more over time.
The postoperative period is relatively short, rehabilitation is not necessary; After a few days, everyday activities can be resumed confidently, but the surgeon’s instructions must be
followed. Postoperative pain can be alleviated by laser or ultrasound therapy.
Removing a wrist or hand ganglion is a minor procedure, complications are rare and extremely rarely serious.
The preliminary examinations carried out before the procedure should ensure that these risks are low.
The possibility that the cyst on the wrist will reappear after treatment always exists. This can be removed again with good chances of success. A further procedure increases the risk of complications, the nearby nerves could, for example, be damaged.