Signs and Symptoms
- Most commonly a visible cystic structure either on the back or palmar side of the wrist. However, ganglion cysts can occur in many other areas. Small cysts may not be visible initially but can cause discomfort.
- The majority are not painful but as they enlarge can cause discomfort
Diagnosis
- Usually obvious on physical exam
- MRI may be necessary when they are small and not able to be seen or felt on exam
Background
Ganglion cysts are benign cysts that arise from inside the wrist joint. They typically appear on the top of the wrist but can also occur on the palm side of the wrist as well. They are not inherently harmful, but the presence of a ganglion cyst can make wrist movement uncomfortable and can lead to stiffness and hand weakness. Treatment typically entails surgical removal.
Treatment
Conservative (Non-Surgical)
- Observation. If one is without symptoms one may prefer to just live with it
- Aspiration of the fluid within the cyst. This may provide temporary relief of discomfort but very frequently the cyst will return.
Surgery
- This offers the best chance of removing the cyst with the least recurrence.
Hand Therapy
Week 1-2:
- 1-2 weeks after surgery, the bulky dressing will be removed. Compressive gloves, fingersocks, or dressings may be applied for swelling management. Typically, a post-op splint is not needed.
- Sutures are removed between 10 and 14 days post-op. At this point, your therapist will begin manual massage techniques to reduce the swelling and soften scar tissue formation.
- Your therapist will teach you particular exercises to increase range of motion at the wrist and fingers, and to allow full movement of the tendons that move through the wrist.
- If needed, techniques will be used to address any post-op pain that exists. Most people do very well, however, and discomfort is usually minimal and resolves quickly.
Week 1-4:
- Wrist stretches will be initiated as soon as the incision has closed, and any discomfort has resolved. If the cyst limited wrist movement at all, it will be important to work on getting full wrist flexion and extension early in recovery, before the scar is mature.
- Your therapist may begin to incorporate other techniques into your sessions to help the tendons move freely, prevent excessive scarring, and help improve inflammation and swelling. This could include therapeutic ultrasound, manual massage, neuromuscular electrical stimulation, compression, and other methods. Post-op discomfort will typically have improved quite a bit by this point in time.
- Therapeutic ultrasound, massage, splinting, or elastic taping may be used, on a case by case basis, to help maximize tissue stretch and achieve full wrist range of motion.
Week 3-5:
- Gradual progressive strengthening will be initiated, to maximize grip, pinch, and forearm strength.
- Returning to work, sports, or other activities will vary for everyone; talk to your therapist or doctor if you have questions. Generally, you should be able to return to most activities by 5-6 weeks post-op.
