About Ganglion Cysts
Ganglion cysts, commonly known as bible bumps, are an extremely common condition that can affect any age group. The most common place for these bumps to appear is on the backside of the wrist, with the second most commonplace being the palm side where the wrist and hand meet. They can occasionally be uncomfortable either because they are in the way when the hand is resting on the table, or they can cause pain with wrist extension (push-up motion). These masses do not cause damage to the surrounding bones, tendons, or ligaments, but they can be either uncomfortable or patients don’t like the way they look.
Cause and Anatomy of a Ganglion Cyst
These masses are made of a collection of joint or tendon lubricating fluid that leaks out of the joint or tendon sheath, making a bubble. While most of these masses arise without a particular cause, they commonly arise after a trauma to the hand or wrist. Trauma can cause a small tear in the soft tissue capsule that surrounds a joint or tendon, allowing the fluid to leak out. These masses can grow, shrink, pop and disappear, or reappear.
Diagnosis of a Ganglion Cyst
Physical exam alone is generally enough for a diagnosis. X-rays may be performed to ensure that there is not an underlying bone or ligament abnormality, especially if there is a history of trauma to the wrist. Occasionally your doctor will recommend an MRI if there is something about the mass that makes it appear a bit different than a standard ganglion cyst.
What Are My Options?
There are both non-surgical and surgical treatment options available. Since these masses do not cause damage to the surrounding tissues, it is perfectly appropriate to leave them alone. If the mass is either unsightly or causes pain your doctor may recommend removing the fluid with a needle or injecting a steroid. This can be performed in the office in just a few minutes with minimal discomfort. The biggest risk of this form of treatment is that there is a roughly 50% chance of the mass returning at some point in the future.
For patients who want more definitive treatment, the mass can be surgically removed. This involves making a small incision over the mass, following it down to the joint, and removing the mass along with the area of the joint that is leaking. While this is a more invasive option than simply draining the mass, the risk of it returning is much lower. As with any surgery, patients should expect some degree of soreness for a few weeks, but in general surgical patients return to normal activities quickly and the risk of the mass returning is low.