A ganglion cyst is a collection of fluid inside a sac. The fluid comes from the joint. The sac is from a weak area in a wrist ligament which then rises to the surface. It is similar to a mushroom with a stalk attaching the cyst at the base. The bump is usually hard and can feel quite solid because it is thick fluid under pressure. Occasionally, there is a known or precipitating cause, such as a fall or an accident. Usually, the cyst simply appears for no known reason. Bumps around the wrist typically occur on the back near the middle of the wrist or on the front on the thumb side of the wrist.

Bumps around the wrist are typically evaluated with an xray.  An ultrasound is usually ordered to confirm that the mass is a cyst, that is, filled with fluid.  In that case, there is almost no chance that it is dangerous or worrisome.  It is then up to the patient to decide if it should be removed.  Typical reasons for removal are either pain or that the bump is getting larger.

Dorsal Ganglion Cyst

The ganglion on the back of the wrist often causes an “achy” feeling. It can be frankly painful with certain positions of the wrist, especially when extending or pushing the wrist back, such as when pushing up out of a chair or getting up from the floor.

Treatment may consist of removing the fluid (yes, with a needle) and possibly injecting cortisone. Years ago, perhaps, the bible was used to smash the mass (because it was usually the largest book in the house!). Though sometimes aspiration is successful and worth trying, usually the cyst returns.

Surgery is recommended if the mass returns and causes discomfort. This is done with a small local incision with the arm asleep as an outpatient surgery.

Volar Ganglion Cyst

These are similar to the ganglions on the back with one important exception. They usually scar to the neighboring artery and aspiration is not recommended. Instead, after confirming by exam and history that there is nothing suspicious about the mass, your doctor may recommend either leaving the mass alone or removing it surgically.

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