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Wrist Ganglion almost disappeared - Exercises ?

Ganglion almost disappeared, it's not first when it disappear and later grown back, should i do Exercises

I would appreciate any help
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replied June 23rd, 2013
Especially eHealthy

You do not state if you received any treatment for the ganglion cyst, or if it went away on its own. But, anyways...

Ganglion cysts (also called synovial cysts) are benign soft tissue masses. They are an outpouching of the synovial lining of joints or tendon sheath. So, they can arise from any synovial joint or tendon sheath in the body. In the hand/wrist, the most common location for ganglion cysts is on the dorsum of the wrist/hand (the back of the hand/wrist) or over the radial artery on the volar side of the wrist (where you take a person's pulse).

The ganglion cyst on the dorsum of the wrist/hand usually arises from the scapholunate joint. The cyst on the volar surface usually arises from the sheath of the flexor carpi radialis tendon.

The natural history of the cysts is usually of the patient noticing a mass or lump. In some cases, there may be some discomfort associated with the cyst (like when doing push ups).

The mass can range anywhere from a soft "water balloon" feeling mass to a very firm (almost hard) lump.

Usually, the mass will continue to grow in size, until the patient decides to have something done about it, or until it is accidently struck, rupturing the cyst wall. The patient may notice that the cyst tends to get larger with activity and smaller with rest/inactivity. The stalk of the cyst has a one way valve in it. Thus, with activity, the joint fluid can be pumped into the cyst, making it larger. But, the fluid cannot get back into the joint (or tendon sheath). With rest, the body will resorb the fluid in the cyst over time.

There are basically three treatments for a ganglion. The first is just observation; in other words, doing nothing. If it does not bother the patient, it does not really need to be treated.

One treatment that is not done much anymore is to rupture the cyst manually. These cysts are often called “bible bumps”, because they used to be broken by striking them with the biggest book in the house, which was usually the family bible. The cyst wall can also be ruptured by “digital pressure”. This is where the surgeon takes his/her thumbs, putting pressure on the cyst until it breaks. This technique can be uncomfortable, so it is not done much anymore. Also, hitting the hand with a very large book can break things other than just the cyst.

The next type of treatment is to aspirate the cyst. This is where a pretty large bore needle is used to “suck out” the contents of the cyst. Since the contents of the cyst look like apple jelly, a fairly large bore needle has to be used. Some surgeons will then inject the cyst with steroids (cortisone), in hopes that the cyst walls will scar together, preventing the cyst from filling back up with joint fluid. After the cyst is aspirated, the patient will need to keep a compression pad on the area where the cyst was for several days, again, to help prevent the cyst from filling up once again. Usually, the surgeon will take several thickness of gauze sponges, placing them over the cyst, and then holding them on with a compressive wrap. This needs to be left in place for about 3-5 days.

The last type of treatment is to surgically remove the cyst. This is a major orthopedic hand surgery. It is not a simple little office procedure. The cyst will need to be completely dissected out and its stalk followed all the way down to its origin. Once it has been isolated, the cyst, stalk and a 1cm piece of synovial lining will need to be excised. The joint capsule is not closed, as this usually causes the cyst to reform. The wound is then closed in layers and the patient is placed in a bulky compressive dressing for post-op swelling control. The patient is instructed to start moving the fingers in the recovery room. Movement of the fingers will help keep swelling down and will help to reduce the chances of the tendons scarring down. After about a week, the sutures are removed and the patient is allowed to advance activity as tolerated.

So, the patient can do any activity that he/she wishes to do, which does not cause too much discomfort. Some patients are able to return to full activity within a couple of weeks. Some take a lot longer to return to activity. Everyone reacts to discomfort in his/her own way. Thus, everyone recovers at his/her own rate.

Also, recovery does not “just happen”, it takes a lot of hard work in therapy. The more the patient puts into therapy, the more he/she will get out of it.

Good luck.
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