1. What Is a Wrist Ganglion Cyst?
The joint capsule consists of two layers: the synovial membrane and the fibrous membrane. The synovial membrane lines the inner surface of the capsule and, together with the articular surfaces, forms the joint cavity. The synovial membrane secretes a sticky fluid called synovial fluid, which nourishes tissues inside the joint cavity and lubricates the articular surfaces, helping maintain joint stability.
When pressure in the joint capsule increases, changes may occur such as the herniation of the synovial membrane outside the joint cavity. This condition is called a synovial cyst, usually located at the weakest point of the capsule.
A wrist ganglion cyst arises from the tendon sheath or joint capsule, most often appearing on the back of the wrist. However, it can also occur on the front)side, or on the ulnar or radial sides. Patients usually notice the cyst as a bulge that becomes visible when the wrist is maximally flexed. The lump is painless, and if smaller than 2 cm, it may disappear when the wrist is extended. Some ganglion cysts can resolve spontaneously without any treatment.
2. Causes of Wrist Ganglion Cyst
The exact cause of wrist ganglion cysts remains unclear. However, joint capsule laxity or overstimulation of the synovial membrane causing excessive fluid secretion may lead to synovial herniation, clinically presenting as a bulge on the wrist. A wrist ganglion cyst may develop due to frequent wrist movements such as:
- Engaging in sports that heavily use the wrist (e.g., volleyball, basketball) without proper warm-up.
- Repetitive wrist strain in housework, leading to capsule stretching.
- A history of wrist injury or sprain.
3. Diagnosis of Wrist Ganglion Cyst
3.1. Clinical Features
A wrist ganglion cyst is benign, non-inflammatory, and painless, except when large enough to impair joint motion. Common features include:
- A round, smooth, soft, slightly mobile mass.
- The size may fluctuate with wrist movement but usually remains stable over time.
- Typically painless; however, pain may occur during acute synovitis, wrist trauma, excessive joint use, infection, or nerve compression caused by a large cyst.
- Pain intensity does not always correlate with cyst size — small cysts may cause more pain than large ones even if they do not cause a bump on the skin surface. Such cases are often mistaken for arthritis and can lead to incorrect treatment.
3.2. Imaging Studies
- X-ray: To rule out bone fractures or bone tumors.
- Ultrasound: To differentiate a synovial cyst from other soft tissue masses such as lipoma or sebaceous cyst.
- MRI: Required for small or deep cysts not visible or palpable on examination.
4. Treatment of Wrist Ganglion Cyst
Although benign, a wrist ganglion cyst may affect wrist function or appearance. Treatment depends on the extent of symptoms and impact on daily activities. Management options include:
- Observation: For cysts that do not cause discomfort or functional limitation.
- Immobilization: Using a wrist splint to restrict movement helps prevent further synovial herniation and reduces cyst size. Immobilization also helps relieve pain, especially when the cyst compresses nearby nerves.
- Aspiration: Draining the cyst fluid can temporarily relieve pain or motion restriction in large cysts; however, recurrence is common.
Surgery: If conservative measures fail, surgical excision of the cyst and repair of the capsule (suturing the stalk connected to the joint) is performed. Post-surgery, wrist immobilization for 2–3 weeks is required before resuming movement. Despite being benign, the recurrence rate of wrist ganglion cysts after treatment remains high. Therefore, surgical intervention is indicated mainly when the cyst compresses nerves or causes significant cosmetic concern.
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