Ganglion Cysts of the Hand and Wrist

THE CLINICAL SYNDROME

The dorsum of the wrist is especially susceptible to the development of ganglion cysts. Ganglion cysts usually appear on dorsum of the wrist in the area overlying the extensor tendons or joint space, with a predilection for the joint space of the lunate or from the tendon sheath of the extensor carpi radialis. These cysts are thought to form as the result of herniation of synovial-containing tissues from joint capsules or tendon sheaths. This tissue may then become irritated and begin producing increased amounts of synovial fluid, which can pool in cyst-like cavities overlying the tendons and joint space. A one-way valve phenomenon may cause these cyst-like cavities to expand because the fluid cannot freely flow back into the synovial cavity.

SIGNS AND SYMPTOMS

Activity, especially extreme flexion and extension, makes the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. It is often the unsightly nature of the ganglion cyst rather than the pain that causes the patient to seek medical attention. The ganglion will be smooth to palpation and will transilluminate with a penlight, in contradistinction to solid tumors, which will not transilluminate. Palpation of the ganglion may increase the pain.

The appearance of a ganglion cyst will often cause the patient to seek medical attention out of fear of cancer.

TREATMENT

Initial treatment of the pain and functional disability associated with ganglion cyst of the hand and wrist should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes the following injection technique. A nighttime splint to protect the fingers may also help relieve the morning symptoms of ganglion cyst. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology.

If the patient does not respond to these conservation modalities, a trial of injection therapy with local anesthetic and steroid is a reasonable next step. To inject a ganglion cyst, the patient is placed in a supine position with the arm fully adducted at the patient’s side and the elbow slightly flexed with the palm of the hand resting on a folded towel.

Although an initial trial of conservative therapy is indicated, ganglion cysts of the wrist and hand will often require surgical treatment. If conservative therapy fails, the aforementioned injection is extremely effective in the treatment of pain secondary to ganglion cysts. Coexistent bursitis and tendonitis may also contribute to wrist pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.