WRIST GANGLION (Synovial Hernia; Synovial Cyst)
DEFINITION--A small, usually hard nodule lying directly over a tendon or a joint capsule on the back or front of the wrist. Occasionally the nodule may become quite large. Wrist ganglions are quite common.
BODY PARTS INVOLVED
Back or front of the wrist.
Tendon sheath (a thin membranous covering to any tendon).
Any of the joint spaces in the wrist.
SIGNS & SYMPTOMS
Hard lump over a tendon or joint capsule in the wrist. The nodule "yields" to heavy pressure because it is not solid.
No pain usually, but overuse of the wrist may cause mild pain and aching.
Tenderness if the lump is pressed hard.
Discomfort with extremes of motion (flexing or extending) and with repetition of the exercise that produced the ganglion.
Mild sprains and chronic sprains of the wrist, causing weakness of the joint capsule.
A defect in the fibrous sheath of the joint or tendon that permits a segment of underlying synovium (thin membrane that lines the tendon sheath) to herniate through it.
Irritation accompanying the herniated synovium, causing continued secretion of fluid. The sac gradually fills, enlarges, and becomes hard, forming the ganglion.
RISK INCREASES WITH
Repeated injury, especially mild sprains. Wrist ganglions frequently occur in bowlers, tennis players, and handball, racquetball and squash players.
Inadequate warmup prior to practice or competition.
Poor muscle strength or conditioning.
If surgery is necessary, surgical risk increases with smoking, poor nutrition, alcoholism, and recent or chronic illness.
HOW TO PREVENT
Participate in a long-term strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care for diagnosis and possible injections of local anesthetic or corticosteroids.
Surgery (usually). Surgery will be conducted under local or general anesthesia in an outpatient surgical facility or hospital operating room.
Your own observation of signs and symptoms.
Medical history and physical examination by a doctor.
X-rays of the area to rule out a bone tumor or unhealed bone fracture.
Calcification of the ganglion (rare).
Recurrence if surgical removal is incomplete.
PROBABLE OUTCOMEGanglions sometimes disappear spontaneously, only to recur later. Surgery is usually necessary. After surgery, allow about 3 weeks for recovery if no complications occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This condition develops gradually.
IMMEDIATELY AFTER SURGERY:
The affected area is usually immobilized in a splint for 1 to 2 weeks following surgery.
If the wound bleeds during the first 24 hours after surgery, press a clean tissue or cloth to it for 10 minutes.
A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
Use an electric heating pad, a heat lamp, or a warm compress to relieve incisional pain.
Bathe and shower as usual. You may wash the incision gently with mild unscented soap.
Between baths, keep the wound dry with a bandage for the first 2 or 3 days after surgery. If a bandage gets wet, change it promptly.
Apply non-prescription antibiotic ointment to the wound before applying new bandages.
Wrap the hand with an elasticized bandage until healing is complete.
AFTER THE INCISION HAS HEALED:
Use ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
You may apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Your doctor may prescribe pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
You may use non-prescription drugs such as acetaminophen for minor pain.
Return to work and normal activity as soon as possible. This reduces postoperative depression and irritability, which are common.
Avoid vigorous exercise for 3 weeks after surgery.
Resume driving when healing is complete.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes before and after exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a wrist ganglion.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may produce side effects.