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Ganglion Cysts - Wrist and Hand Lumps and Bumps 

Introduction
Ganglion Cysts are a common condition.  They are not harmful or cancerous, although they may cause some people discomfort.  Ganglion Cysts usually appear as bumps on the back of the hand and at either side of the wrist.  They are also called “Bible Cysts” because in the past, treatment included hitting them with a Bible or a large book.  Today, of course that practice is no longer accepted.  Instead, individuals with Ganglion Cysts have several professional treatment options to choose from. 

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Anatomy
Our wrist complex contains many joints.  The joints are composed of several bones in the hand and two bones in the forearm.  The wrist joints function to position our hands and fingers for movement.
 
The bones in our hands are covered with smooth cartilage and connected with ligaments.  Ligaments are firm tissues that provide support and enable us to position our hands for finger movements. The ligaments are lined with a Synovial Membrane.  The Synovial Membrane secretes a thick liquid called Synovial Fluid.  The Synovial Fluid acts as a cushion and lubricant between the joints, allowing us to perform smooth and painless motions. 
 
Ganglion Cysts arise from the fluid filled areas on the ligaments or between the bones.  The cyst is a round sac-like structure filled with Synovial Fluid.  The fluid is harmless and not cancerous.  The fluid can become thick over time, making the cyst feel firm and spongy.  It is common for cysts to grow larger, but they will not spread to other parts of your body.  Ganglion Cysts occur most frequently on the back of the hand and wrist.  These cysts, called “Dorsal Wrist Ganglions,” are the most common type of cyst.  Ganglion Cysts occasionally develop on the palm side of the wrist near the thumb and on the fingertips, just below the cuticle.  Ganglion Cysts can appear on the lower extremities as well.  They may form on the outside of the knee or ankle and on the top of the foot.

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Causes
Overall, Ganglion Cysts occur more often in women.  The cause of Ganglion Cysts is unknown.  One theory suggests that trauma or stress at the wrist joints may cause degeneration and the formation of cysts.  This may occur in individuals who participate in activities that are strenuous to the hand, such as gymnastics or meat cutting.  According to this theory, prior wrist injuries that are re-injured may be susceptible to Ganglion Cyst development.
 
The second, most likely theory is that the Ganglion Cysts form because of structural flaws in the joint tissues.  The cyst may develop when Synovial Fluid collects between the joints.  As the fluid builds up, it may create a bulge where the tissues are weakened.

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Symptoms
Ganglion Cysts can be so small that they are not noticeable underneath the skin.  They can also become large, over one inch in diameter.  It is very common for the cysts to increase in size.  They may also come and go or disappear forever.  The unattractive appearance of these cysts is what often leads patients to seek treatment for them.
 
Some cysts are painless, but the majority cause some degree of discomfort.  The pain is usually continuous and may become worse with activity.  You may experience a tingling sensation, considerable pain, or numbness if the cyst is pressing on a nerve.

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Diagnosis
You should have your physician evaluate a suspected Ganglion Cyst, but it is not a medical emergency.  Your doctor can diagnose a Ganglion Cyst by performing an examination and talking to you about your symptoms.  Your doctor will feel your cysts and ask you about their degree of tenderness.
 
Sometimes doctors use Needle Aspiration to confirm the diagnosis of a Ganglion Cyst.  This simple procedure involves numbing the area and then using a syringe and needle to draw fluid from the cyst.  The fluid is examined to confirm the diagnosis and rule out any other condition.
 
In some cases, physicians use imaging tests, such as ultrasound or Magnetic Resonance Imaging (MRI) scans, to determine more information about the cyst.  An ultrasound uses sound waves to create an image when a device is gently placed on your skin.  A MRI scan provides a very detailed view of the cyst and surrounding structures.  The MRI scan requires that you remain very still while the pictures are taken. Both tests are painless.  The tests are helpful to determine if a cyst is fluid-filled or solid.  The images can also identify if an artery or blood vessel is causing the bump.

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Surgery
Outpatient surgery is recommended if the Ganglion Cyst is painful, causes numbness or tingling, and interferes with functional movement.  In some cases patients want the cysts removed because of their unattractive appearance. 
 
Your surgeon will numb the area before removing the cyst.  Following the surgery, you will wear a splint on your wrist for a few days.  Your doctor may recommend therapy to mobilize and strengthen the joints.

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Treatment
Some Ganglion Cysts require no treatment and disappear on their own.  Your doctor may recommend that you wear a wrist splint.  This can help relieve pain caused by activity. 
 
Physicians may also use Needle Aspiration to treat Ganglion Cysts.  Your doctor will numb your wrist area for the procedure and remove the fluid from the cyst using a needle and syringe.  The site will then be injected with an anti-inflammatory steroid medication.  Needle Aspiration is a fairly successful treatment, although some individuals may need to have it repeated a few times.  Your wrist will be splinted following the procedure to promote healing.  
 
Therapy is sometimes utilized after surgical and non-surgical treatment.  Your therapist will teach you exercises to mobilize your joints.  This may be helpful for reducing swelling and discomfort.  You will also learn exercises to increase your hand strength, flexibility, and coordination.  The goal of therapy is to restore maximum function to the wrist and hand.

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Recovery
Recovery from surgery differs from individual to individual, depending on the size of the cyst and the extent of the surgery.  Recovery typically takes from about two to six weeks.  In a few cases the cysts may return.  However, the majority of people experience successful results with surgery.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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