Ganglion cyst of the wrist is the most frequently occurring soft-tissue mass in the wrist or hand; this cyst type accounts for 50-70% of all the masses affecting these parts of the human body. A person might develop ganglion cysts at any age; however, the condition is most common among people in their 20s, 30s and 40s. Women are three times higher at risk of getting the condition compared to men. Elimination of ganglion cyst in wrist pain and deformity caused by the condition on most occasions is done through surgical removal of the masses.
What are the common complaints made by patients with ganglion cysts?
Patients suffering from this condition complain about the unsightly appearance of the affected wrist, which is usually accompanied by weakness and pain in the region. Around 10% of ganglion cyst patients get the disease as an aftereffect of a traumatic event. Medical experts believe that a series of minor traumas can also result in ganglion cysts. These cysts are rubbery or firm structures having a size ranging between 1 and 3 cm; a ganglion cyst never stays fixed to the patient’s skin. Pain caused by a ganglion cyst in wrist tends to get worse on moving the affected wrist, especially when the motion is at the extremes. The pain, although persistent, is mostly dull in nature. It has been found that the smaller ganglions cause more severe pain compared to the large ones.
Clinical studies have shown that the emerging ganglions may pass through the fourth dorsal extensor tendon compartment, compressing the patient’s posterior interosseous nerve. In rare cases, a patient with volar ganglion cysts can develop trigger digit or carpal tunnel syndrome when the cysts pass through his or her ?exor tendon sheaths.
How are the effects of ganglion cyst diagnosed?
The process of diagnosis involves radiographs and aspiration of mucinous, a jelly like substance present within the cysts. These tests reveal whether or not any interosseous component exists. Differential diagnoses of the condition, on the other hand, include proliferative tenosynovitis and solid tumors. While the ganglion cysts remain stationary, the proliferative tenosynovitis moves with the patient’s long flexors and extensors.
Till date, no medical study has found out the exact causes of ganglion cysts. Medical practitioners and scientists of different eras came up with different theories regarding the factors causing ganglion cyst on the wrist. Eller in the year 1746 and Volkmann in the year 1882 suggested that these cysts appear as a result of herniation of the synovial membrane of the joints. The theory suggesting that a ganglion cyst arises from connective tissues constitute the basis of a large share of the theories existing today. This theory first surfaced during the 1890s. In the year 1928, however, another group of scientists suggested that ganglion cysts appear as a result of mucinous degeneration of the connective tissues, a state mostly triggered by chronic damages. These scientists believed that communication of the ganglion cysts with the patient’s joint capsule resulted from the capsule’s degeneration. This postulation was reinforced again in the year 1966 by Soren. Soren also stated that ganglion cysts can result from constitutional factors as often patients develop multiple ganglions in their ankles and wrists. Currently, most of the investigators support the fact that a ganglion cyst originates from modi?ed synovial cells located on an individual’s synovial-capsular interface as a result of frequent minor injuries.
When examined under an optical microscope, a ganglion cyst appears to be a multiloculated or single structure having a shiny and smooth lining. Electron microscopy, on the other hand, reveals that walls of these cysts are primarily made up of collagen sheets sequenced as multidirectional strata. Examination under electron microscope also shows presence of some flattened cells similar to the fibroblasts; absence of a synovial or epithelial lining is also marked. Most ganglion cysts stay filled with a highly viscous, clear fluid having jelly-like texture, which is a lot denser than the synovial fluid. The higher viscosity of this fluid is due to its high hyaluronic acid concentration and presence of other mucopolysaccharides.
Ganglion cyst on wrist is classified into two types depending on the part of the wrist affected by the condition. They are:
- Ganglion cysts of the dorsal wrist: The dorsum of one’s wrist is the most common site of ganglion cysts. This type of the condition accounts for approximately 60-70% of all wrist and hand ganglion cysts. A ganglion on the dorsal wrist generally appears directly on the patient’s scapholunate ligament.
- Ganglion cysts of the volar wrist: This ganglion cyst type accounts for approximately 18-20% of all wrist and hand ganglion cysts. The most commonly affected body part by volar wrist ganglions is the area beneath the crease of the volar wrist. Generally, a volar ganglion cyst originates from the patient’s scaphotrapezial joint or radiocarpal joint.
How are ganglion cysts on the wrist treated?
Ganglion cyst wrist treatment may include the use of a combination of conventional remedies and alternative medicines. If the fluid is still not thick, your doctor might opt for draining the fluid out using a needle. This treatment might not be effective in removing the older ganglion cysts as mostly with time the fluid gets thicker. In such cases, ganglion cyst wrist surgery is the only option. It is believed that ganglion cyst removal through surgery reduces the chances of recurrence of the condition to 5-10% when the joint capsule’s check valve gets removed. Nowadays, doctors also recommend a minimally invasive surgical procedure called arthroscopy for ganglion cyst removal.
The alternative treatments for ganglion cyst in wrist include the use of herbal and homeopathic medications. Curcumin, a therapeutic compound found in turmeric is believed to effectively treat these cysts due to its excellent anti-inflammatory qualities. Some herbalists also suggest that topical application of a mixture of fresh pineapple juice and turmeric paste can reduce the inflammation of ganglions. The most tried and tested homeopathic remedy for ganglion cysts is Silicea. Silicon oxide is the active ingredient of Silicea; the medicine works by reducing swelling and gradually eradicating the cysts. Silicea is available in solutions, capsules and tablets.