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Margaret Senn Schwartz, OTR , Certified Hand Therapist

Ganglion Cysts
T he most common type of soft tissue mass In the hand is a ganglion cyst, a type of lump which appears near a joint or tendon. It is similar to a sac or balloon which is filled with a clear, gel-like fluid. It may be soft or hard, and sometimes can become painful or even painless. They often appear or disappear on there own, and often with no apparent cause. Ganglions are famous for appearing and disappearing on there own, as well as for getting bigger or smaller spontaneously. They are also called mucous cysts, mucinous cysts, or synovial cyst.

What causes it?

     Our joints and tendons are lubricated by a special liquid called synovial fluid, which is contained in a compartment. When we use our hands for normal activities, our muscles and joints squeeze the fluid and create pressure in the lubricating compartment. Also, sometimes because of arthritis, or injury, a small portion of fluid leaks out of the compartment.

     The synovial fluid is the lubricating liquid which has special proteins and therefore is not easily reabsorbed once it has leaked. The liquid can become thickened and harder with time and becomes more of a "lump" that can be seen or felt.

     Occurrence is higher in women with 70% between the ages of 20 and 40, but can occur at any age or gender. Ganglions occurring at the last finger joint (mucous cyst) are associated with Osteoarthritis and older ages. Occult ganglia can occur in young gymnast due to joint stress onto the wrists.

Common sites for ganglions are:

     The most common site is the back of the wrist and is called a dorsal wrist ganglion, which accounts for 60-70%. These can arise from the wrist joint spaces, and are sometimes irritated by a wrist sprain. They can also occur at the front part of the wrist or palm side, thumb area, and the palm area for the fingers.

What you can do?

     Wait and see if it gets smaller and reabsorbed. Non-steroidal anti-inflammatory medication (NSAID), such as aspirin, ibuprofen, or naprosyn can be helpful.

     Historically, an old "non-medical" remedy was to hit the lump with a heavy book, in order to rupture the cyst. This can cause injury and even if successful, the lump may return larger than the first. The legend is that treatment involved using a Bible , thus the name "Giddeon's disease" was born.

What can a therapist do?

     Provide a special hand splint to support the area. Suggest ergonomic modifications to daily activities or work duties which may be problematic

What can a doctor do?

     Confirm the problem is a Ganglion cyst and not anything else serious

     Drain or aspirate the fluid from the cyst with a needle, and possibly inject the area with cortisone. This works well for cysts coming from the tendon.

     Perform surgery to remove the cyst and clean out the area where the cyst comes from.

     This information is not meant as a self help directory or for the purposes of dispensing medical advise. Any use of medication or treatment of a suspected problem or symptom should be done only after consulting ones' physician. It is important that if you suspect any problem to consult your medical doctor first, or possibly a Hand Surgeon which specializes in the treatment of the Hand and Upper Extremity.

     Ms. Schwartz is a Registered Occupational Therapist at Elizabeth General Hospital in Elizabeth,N.J. She graduated from Towson University in 1983 with BS in Occupational Therapy. She also worked at Kessler Institute for Rehabilitation in New Jersey, a world renowned hospital for rehabilitation.

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