Ganglion Cysts
What are they ?
Ganglion cysts are small, benign, fluid-filled sacs.
Most of the time they are painless and are more of an aesthetic issue.
Typically they can be found on the top or back of the wrist.
When synovial fluid leaks from a joint or tendon sheath, this causes a thin wall to develop around it and this equates a cyst.
RISK FACTORS
Age and Sex: Can occur at any time to anyone, but there is a higher prevalence noted in females aged between 15–40 yrs.
Overuse: Repetitive wrist impact; seen in sports such as gymnastics and acrobats. Wrist impact heightens during activities such as tumbling or hand balancing.
Trauma: They may form following a single incident or reoccurring small injuries. For example, A fall onto an outstretched hand.
Treatment
Overall, treatment is highly dependent upon pain and dysfunction.
Approximately half will resolve on their own, but dependent upon size and location.
If pain is present, hand use is limited, restricted or there is nearby compression of a nerve (altered sensation, pins and needles or numbness) > Then treatment is recommended.
Splinting: Can be useful in the short term to help offload from irritation, particularly if there has been an increase in swelling and cyst size.
Strapping: Similar to a splint, but less rigid and thus, can aid in a higher level of activity.
Activity Modification: You can discuss with your physiotherapist the appropriateness of certain movements and exercises and whether or not any specific sporting restrictions need to be put into place.
Biomechanical Analysis: Is there a restriction in a surrounding joint that could be placing the wrist in a more provocative position? For example, reduced range in the elbow or shoulder can impact wrist load.
A corticosteroid injection or aspiration (Drainage via needling), may be deemed appropriate. The recurrence rate following aspiration ranges from 50-60%.
If surgical excision has been deemed appropriate, physiotherapy is necessary to reduce post-operative complications. Hand and wrist function needs to be restored, as with a graded return to your chosen sport or training. Additionally, scar tissue is also managed. The recurrence rate after surgical excision is approx 10 - 40%