Lumps that appear on the wrist are usually noncancerous. Most often, they are ganglion cysts. These fluid-filled sacs are not a threat to health. Doctors can remove them if they become painful or interfere with movement. Some people opt to have them removed because of the way they look.
Typically, ganglion cysts are oval lumps less than an inch long. If you could see inside the wrist, you would notice that they look like small balloons on a stalk. They grow out of the wrist joint and hold a thick liquid like the one that lubricates joints.
Surgery vs. Other Treatments
Before removing cysts surgically, doctors often advise other approaches, including:
Watchful waiting. Most people with ganglion cysts on the wrist have no symptoms. Doctors often suggest waiting to treat such cysts. Up to 58% of ganglion cysts on the wrist may go away on their own.
Splinting the wrist. Moving your wrist may make the cyst get larger. Doctors may suggest using a splint or brace to reduce movement. Splinting has some drawbacks. It can make it difficult to carry out your job duties and the activities of daily living. Also, if used for a long time, splints may weaken your muscles.
Aspiration. Doctors can use a needle to draw fluid out of the cyst. Sometimes the fluid is so thick that it is hard to get out. Also, the cyst may recur because the structure of the cyst remains in place.
Reasons for Choosing Surgery
You may opt for surgery on cysts on your wrists. The reasons for wanting surgery vary. In one study, 38% chose surgery for cosmetic reasons. About 25% chose surgery because they were worried about the risk of cancer, even though cysts are rarely malignant. Another 25% chose surgery to reduce pain.
Ganglion cysts on your wrist may come back after surgery. It’s difficult to know exactly how common this is. Studies have reported recurrences as low as 0% and as high as 31.2%.
Surgery to Remove Cyst From the Wrist
Doctors usually do ganglion cyst removal on an outpatient basis. Surgeons may use traditional surgical techniques or arthroscopy.
In arthroscopic surgery, doctors make a small incision and insert a tiny camera into your joint. Additional small incisions allow them to insert surgical instruments. Arthroscopy lets surgeons do surgery without large incisions and with minimal scarring.
The difficulty of surgery depends partly on the location of the cyst on your wrist. Most cysts occur on the back or dorsal side of the wrist. About 20% appear on the underside of the wrist, near the palm of the hand. These are called volar cysts, and they are harder to remove.
Dorsal cysts. Cysts on the back of the wrist are removed through a crosswise cut. Surgeons must use care to avoid damaging the ligament in the middle of your wrist. They remove all of the cyst, including the stalk-like part, to keep the cyst from coming back.
Volar cysts. Cysts on the underside of the wrist are difficult because surgeons must avoid the radial artery. They must also work around a major nerve on the inside of your wrist. These structures make it harder to remove all the cyst. Incomplete removal can lead to a recurrence of the cyst.
Risks of Ganglion Cyst Surgery
Besides the chance of recurrence, surgery can have some other negative results. Pain in the wrist doesn't always go away after surgery. Some who have had surgery report a loss of grip strength. Some lose mobility in the joint.
Other negative outcomes of surgery include:
- Infection of the surgical site
- Formation of a neuroma, an abnormal mass of nerves
- A thickened scar
- Damage to the median nerve
- Damage to the radial artery
After ganglion cyst removal, doctors usually prescribe medication for pain management. They may also suggest an anti-inflammatory medicine such as ibuprofen. Elevating your hand and using ice packs can help with your pain.
Doctors may or may not require a splint after surgery. Gentle movement can help with the pain, so doctors may not want your arm splinted. In more complicated surgery, such as some volar cyst surgeries, a splint may be helpful.
Some swelling at the surgery site can persist for 2 or 3 months.
Length of Recovery
Recovery time for ganglion cyst removal depends upon the extent of the surgery and other factors. Full recovery can take 2 to 6 weeks.
If you have had cyst removal surgery, you may need up to 24 days off from work. The average is around 2 weeks. You may need occupational therapy to make a full recovery.