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Home Health Wrist ganglions – small in size, big in aggravation
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Wrist ganglions – small in size, big in aggravation
Written by Ken Chisholm, RN; BS; CNOR; CRNFA; OPA   
Thursday, 10 September 2009 15:38

Ever wonder what that annoying bump is on the top of your wrist? Or why it


gets bigger when you use your hand a lot? And how it gets sore, or just how it got there in the first place?

If you are one of the millions of people who suffer from a painful bump on the wrist that changes size with activity, gets sore as it enlarges, and won’t go away, you may actually have what is called a “wrist ganglion.”

Merriam-Webster defines a ganglion (pronounced “gan-glee-on”) as a “small, cystic mass connected to either a small joint or tendon sheath.” While these cysts can appear almost anywhere, the most common location is the wrist.

Ganglions can be found on either the top (dorsal) aspect, or the palm side (palmar or volar) aspect of the wrist. Both can be uncomfortable and can cause trouble with mobility of the wrist, especially in work or sporting activities that demand repetitive hand and wrist involvement. The volar wrist ganglion can be a trickier problem to deal with.

 

Ganglions are frequently formed as a result of some kind of defect in either the small ligaments that connect the carpal bones of the hand, or a small tear or rupture of the sheath of one of the tendons that pass through the wrist. Fluid from these small joints and tendons then leeches out into the surrounding tissue and forms the cyst. As activity increases, so does fluid production. Movement and activity are responsible for the changes in size of the ganglions.

So, how are they treated?

Well, you could smack it with a Bible. An old wives tale suggests that if you strike a wrist ganglion with a Bible, the cyst will disappear. While it isn’t recommended that you go around “smacking yourself with a Bible” or any book for that matter, there is some fact behind the fiction.

The truth is, if you strike a ganglion cyst with a Bible, or any book, it can cause the cyst to rupture. (People have reported accidentally bumping the ganglion, having short-term pain and swelling, and then the cyst disappeared). This, in turn, causes the cystic fluid to dissipate into the tissue. It also creates some inflammation, which leads to scar formation that ultimately “seals” off the source of the fluid.

Today, thankfully, there are more sophisticated means of treating these troublesome cysts.

For the most part, wrist ganglions don’t require any formal treatment; that is, unless or until they become chronic and persistent in their discomfort, or interfere with function or activities.

When treatment is needed, options can include local aspiration (draining) of the thick fluid with injections of a small amount of cortisone into the cyst. This has long been a tried-and-true treatment option. This treatment is typically more successful with the dorsal ganglion variety.

If it’s a volar wrist ganglion you’re contending with, treatment can get a bit more complex, primarily because of anatomy. You see, one of the main arteries of the forearm and wrist, the radial artery, courses through the palm (volar) side of the wrist along the thumb-side of the forearm. Ganglions of this nature tend to form right where the artery passes by and can frequently become entangled with, and wrapped around the vessel. Because of this anatomical consideration, aspirations and injections can become more problematic because there is an increased risk of injuring the artery with a needle.

With this in mind, treatment of volar wrist ganglions is aimed more at primary surgical removal and is typically performed without any ill effects to the radial artery. Many hand-fellowship-trained surgeons perform these procedures on a regular basis.

So, if you have this “bump” and it hurts on occasion, and it gets bigger with activity, and it’s located on either side of the wrist, you may have a wrist ganglion.

Put your Bible down and go get it checked out.

Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care. For additional information on orthopedic related topics, visit Ken’s Web site at www.bone-and-joint-pain.com.

An old wives tale suggests that if you strike a wrist ganglion with a Bible, the cyst will disappear, however, thankfully, there are more sophisticated means of treating these troublesome cysts. (Picture courtesy of www.uoregon.edu)

 
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