Should I be worried about the lump on my wrist?

If you have ever noticed a small bump on the back of your wrist or near a finger, it could be a ganglion cyst. I have one on the pinky side of my wrist and I had it checked about one year ago by my primary care physician. I was surprised when it went away completely a few months later without any treatment, only to see it re-emerge this past year.

“A ganglion cyst is a little balloon or sac filled with a thick jelly-like fluid and usually grows from a tendon sheath or joint capsule in the wrist,” explained Brian Najarian, MD, an orthopedic and hand surgeon with Cape Cod Orthopedics and Sports Medicine in Hyannis. “The most common area where they grow is the back side of the hand (envision a line running from your middle finger to the middle of your wrist) and the second most common is on the palm side of the wrist towards the thumb but I have seen them on mostly any joint.”

Dr. Najarian shared some interesting facts about ganglion cysts:

• There is no specific age when they can develop. He has seen them in patients as young as 13-14 years old and patients in their 60s and 70s.
• Some are painful, some are not. In some situations, the pain occurs only with push-up positions such as in yoga or pushing up from a sitting position in a chair to a standing position.
• The cysts can range from just a few mm (mucous cyst) to > 7 or 8 cm.
• Ganglion cysts can be a result of irritation of the joint or tendon, trauma or arthritis. Sometimes, there is no reason why they develop.
• Ganglion cysts that form on the nail side of the finger are typically associated with arthritis in the finger joint and are also called mucous cysts.
• We only see about 10 percent of the ganglion cyst because, like an iceberg, the cyst is much larger under the skin and looks like a balloon on a stalk. It can impinge on normal structures of the hand in that area or press on a nerve or blood vessel and cause pain.
• One way of diagnosing a ganglion cyst is shining a light on it. When Dr. Najarian examines a cyst, he shuts off the overhead light and uses a handheld light to shine on the cyst. Since fluid transmits light better than solid, the cyst glows in response to the light.
• Years ago, before other medical options were available, doctors historically used heavy books to treat cysts and cause them to burst by hitting it with the book. It was called the “Bible bump” because it was usually the biggest and heaviest book. This is not recommended today, as there are other options to treat the ganglion cyst, and risk of injury from using the book is very high.

Treatment Options

Dr. Najairan offers three treatment options to patients when he sees them in his office. The options are:

• Observation
• Needle aspiration to remove the fluid in the cyst
• Surgery to remove the cyst entirely.

With all three options, the cyst can recur, although surgery has the lowest recurrence rate, he said. Patients also have the option to have a steroid injection to relieve the tendon or joint irritation and calm that down.

“Ganglion cysts are non-cancerous but if you have a mass near your joints or on your hand, you should have it checked,” Dr. Najarian said. “It’s always good to have your primary care physician confirm it is a ganglion cyst and reassure you. While primary tumors of the hand are very rare, you shouldn’t necessarily assume it’s a ganglion cyst.”