In the “old days,” a condition called ganglion cysts was referred to as “Bible bumps,” because doctors would tell people to “just smash them with a Bible.” I don’t recommend that because there have been instances of people breaking bones in the wrist that way (turning a little problem into a big one!).
Ganglion cysts are the most common mass in the hand and wrist. They are usually found on the back of the wrist, but also can be found in many other places on the hand and wrist. Smaller cysts can look (or feel) like bumps; the larger ones can look or feel like bubbles, balloons, or balls under the skin.
The cysts are full of fluid—usually from a nearby joint. This fluid lubricates the joint so that the surfaces can glide on each other. Sometimes, excess fluid forms pouches called ganglion cysts. We really don’t know what causes them, although there might be a genetic and/or biological cause. Some cysts appear when the joint is inflamed, due to arthritis. There rarely is a history of trauma to the area, but patients sometimes attribute cysts to a fall or injury.
Ganglion cyst symptoms
Most ganglion cysts do not cause significant symptoms. Those on the back of the wrist sometimes can cause pain when someone is pushing up from a seated position or otherwise leaning with the wrist extended (push-ups, yoga, etc.). Cysts on finger tendons—retinacular cysts—can be irritated with gripping activities such as lifting weights. If the cyst is large, it might press against tendons or nerves in the area and cause mild related symptoms. Cysts associated with arthritic joints can be painful, but that might be due to the inflamed joint rather than the cyst itself. A special category of these is the mucous cyst, which is found at the joint of the finger next to the nail. These cysts can press on the area that generates the nail, causing ridges or other deformities.
Because ganglion cysts are benign (not cancerous), observation is the most common treatment. Some cysts go away on their own. Non-operative treatments might include splinting or wrapping, anti-inflammatories, and modifying activities to decrease symptoms. A hand surgeon may aspirate (remove with a needle) fluid from the cyst and/or inject it with cortisone.
Surgery can be performed to remove the cyst by going all the way down to the joint (or tendon) where it originates. Surgery carries with it the least risk of recurrence, but unfortunately, in ten to 20 percent of cases the cyst still can recur. Treatment choices should be discussed with an orthopaedic surgeon. To learn more about ganglion cysts, visit OrthoInfo.org or ASSH.org.