Wrist Ganglion Cyst

Just realize I've been writing blogs every day. Those who only read my blog once in a while should find it hard to keep up with me. :P This tells you if you want to know how have I been, then visit my blog as often as you can! lol!

Today's blog is more on the medical field. Why medical field? Because I just went for a check up on my wrist this afternoon. There's a lump at the back of my wrist and it seems to be getting more and more obvious.

It's scary when you step into a clinic. I'm a little scared especially when I think of last time when I found a lump (it grew twice) and had 2 minor operations to have them removed. The first operation the doctor gave me local anesthesia (I was awake the entire procedure) and in the second operation, the doctor only gave me tranquilizer or whatever it is called to calm me down during the operation.

This time I went to see the very same doctor, Dr. Hew. He asked whether the lump I removed last time regrow and I replied no. (I was horrified later on to learn that I have to go for another check up 1 1/2 years later). I showed him the lump at the back of my wrist. He pressed it at every angle, asked me a few questions (is it painful? how long has it been there? etc.) and asked us not to worry. He explained the lump is probably due to a leak of the fluid from within the joints (synovial fluid), forming a balloon like sac at the back of the wrist.

He explained more, making sure we understand what it is about but anyway, I still look it up in the internet and found some infos in different websites:

Looks small when I didn't bend my hand


The lump's clearer from side view and when I bend my hand.

What is it?
In the hand, a ganglion is a particular type of lump which shows up next to a joint or a tendon. Inside, it is like a balloon filled with a thick liquid. It may be soft or hard, may or may not be painful, and may get bigger or smaller on its own (mine is getting bigger). It may also be referred to as a mucous cyst, a mucinous cyst or a synovial cyst. Ganglion cysts are not cancerous (Phew!), will not spread, and while they may grow in size, they will not spread to other parts of your body.

Cause

• Normally, joints and tendons are lubricated by a special liquid which is sealed in a small compartment. Sometimes, because of arthritis, an injury (I have a feeling mine is due to an injury), or just for no good reason, a leak occurs from the compartment. Now, the liquid is thick, like honey, and if the hole is small, it can be like having a pinhole in a tube of toothpaste - when you squeeze the tube, even though the hole is small and the toothpaste is thick, it will leak out - and once it is out, there is no way it can go back in on its own. It works almost like a one way valve, and fills up a little balloon next to the area of the leak. When we use our hands for normal activities, our joints squeeze and create a tremendous pressure in the lubricating compartment - this can pump up a balloon leak with so much pressure that it feels as hard as a bone.
• The lubricating liquid has special proteins dissolved in it which make it thick and also make it hard for the body to absorb it when it has leaked out. The body tries to absorb the liquid, but may only be able to draw out the water, making it even more thick. Usually, by the time the lump is big enough to see, the liquid has gotten to be as thick as jelly.

Symptoms
Because the fluid-filled sac puts pressure on the nerves that pass through the joint, some ganglion cysts may be painful (I feel the pain before I saw the lump. In fact, when I discovered the swelling, the pain has subsided) . Large ganglia, even if they are not painful, are unattractive. Smaller ganglions that remain hidden under the skin (occult ganglions) may be quite painful.

A ganglion grows out of a joint, like a balloon on a stalk. It rises out of the connective tissues between bones and muscles. Inside the balloon is a thick, slippery fluid similar to the fluid in your joints. Usually, the more active the wrist, the larger the cyst becomes (and my lump is getting bigger. Maybe I put too much pressure on it). With rest, the lump generally decreases in size.

Will the cyst go away?
Sometimes, wrist ganglion cysts go away with no treatment, most of the time they linger around or even grow larger. Some cysts form a type of one-way valve such that fluid enters the cyst easily, but cannot escape. When the ganglion cyst becomes large enough, it will begin to put pressure on surrounding structures. This pressure can cause painful symptoms, and is usually the reason these ganglion cysts are removed.

Treatment

• Wait and watch. (this is what Dr. Hew suggests)
  
• "Over the counter" non-steroidal anti inflammatory medication (NSAID), such as aspirin, ibuprofen, naprosyn, or ketoprofen. Check with pharmacist regarding possible side effects and drug interactions.
• Some people, following non-medical advice, will smash the lump with a heavy book (Ouch!), and rupture the cyst. (not recommended). The lump can come back even if it has been successfully treated this way. The urban legend regarding this traditionally involves using a Bible as the book, leading ganglions to be called "Giddeon's disease" in some circles.
• Immobilization. Provide a variety of hand splints to support the area. Activity often causes the ganglion to increase in size. This is because activity increases pressure on nerves, causing pain. A wrist brace or splint may relieve symptoms, letting the ganglion decrease in size. As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.
• Aspiration. Drain the cyst with a needle and possibly inject the area with cortisone. This works much better for cysts coming from the tendon than those coming from joints. (Doctor mentioned this. But he still suggests we wait because even if we drain the cyst, it might still grow back)
  
• Perform surgery to remove the cyst and clean out the area where the cyst comes from. (heard that it's gonna hurt. Not sure if it's this surgery or aspiration but I suppose it's surgery that hurts)
  

What happens if you have no treatment?

• Painful cysts may be painful because of underlying problems other than a simple cyst. Although uncommon, pain associated with a ganglion may be due to underlying arthritis, bone tumor, ligament injury or fracture.
• Cysts can extend into the underlying bones and cause other types of problems.
• Cysts on the back of the end joint of the finger (mucus cysts) may gradually thin and weaken the overlying skin, allowing liquid to drain out but also allowing bacteria to enter the joint, sometimes causing a serious infection.

Sources:
http://www.eatonhand.com/hw/hw013.htm
http://orthopedics.about.com/cs/handwristsurgery/a/wristganglion.htm
http://orthoinfo.aaos.org/topic.cfm?topic=A00006

Hope the lump won't inflict any pain! I seriously don't ever want to step into the operation room again nor I ever want to see needles stuck on my hand!!