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When you notice a growth on your wrist that appeared seemingly overnight, it is not surprising to think it could be some type of tumor or bone spurt that formed around your wrist. Although possible, a far more likely cause would be ganglionic cysts.

If you have a hard mass that feels like a bone around the surface of your wrist, there is a chance that you could have some type of bony growth or tumor but the law of probabilities state that this is more likely caused by a wrist ganglion. These cysts are common in any age group but are more prominent in patients aged 20 to 40 [1]. Why these happen is very puzzling and treatment options can be even more frustrating. Here, we will present some risk factors, symptoms to watch out for and treatment options to help you manage these wrist ganglia. 

Risk Factors for Ganglionic Cysts 

Ganglion cysts on the wrist are a very common occurrence in the general population. Prevalence rates can be as high as 25/100,000 in males and 43/100,000 in females. Of these cases, only 19 percent report pain with this growth. [2] The majority of these cysts, will be found on the dorsal surface (the back side) of your wrist [3]. Because of their sudden appearance, many patients will come to the Emergency Department questioning about "the hard lump on my wrist" and understandably describe it as something the "feels like a bone or a tumor."

In reality, what has happened was the tendons on your wrist have caused cysts to form. This type of presentation is not soft because you will typically have a complex network of micro-cysts that are part of this ganglion giving it a very rigid architecture. The thing that is confusing to doctors is how this fluid gets there in the first place. There are no real areas around your wrist where this fluid could leak from and studies show that chronic inflammation would not lead to fluid pooling into the joints so the simple answer is "we just don't know why it happens." [4]

What is known is that there is not a strong history of trauma to the joints prior to the emergence of these cysts. Studies find that patients can only recall blunt trauma to the wrist before the growth of these cysts 10 percent of the time.  The only real risk factors we can identify is the sex of the patient and a family history of these manifestations. 

Symptoms To Watch Out For 

To help differentiate between ganglionic cysts, bony outgrowths or tumors, physicians can get a pretty good idea already after a simple physical examination.

  • Ganglia are usually between 1 to 2 centimeters in length and will feel like you are touching a small rubber ball when you are touching it.
  • If you have a bone tumor, it is more likely that you will not find a superficial protuberance that you can touch and you would also be in excruciating pain when you touch the spot. Most of the time it will be composed of soft tissue so it will not have the same solid texture you can make out when dealing with ganglia. [5]

When dealing with ganglia, patients will also report pain that can travel up the length of their arm. They will have a restricted range of motion and will not be able to hold objects with a firm grip. In extreme cases, patients may also have numbness in their forearms and their hands because the median and ulnar nerves could be compressed under this ganglionic bundle. [6] Lastly, the pain that you may experience with this type of pathology is often described as irritating but manageable. You should still be able to carry on your daily life. If you had an actual tumor, that would not be the case. [7]

Treatment Options to Consider 

The issue with these ganglia is not only are they hard to predict, they are also pretty challenging to treat.

  • The first-line therapy for patients presenting with ganglionic cysts is to try some type of non-surgical treatment first. This is typically in the form of fluid aspiration using ultrasound guidance. The doctor will take a syringe and drain the fluid to help the patient find relief. Studies are inconclusive on the effectiveness of this option with some reporting a remission rate of nearly 85 percent after 3 aspirations while others suggest success rates closer to 50 percent [8]. 
  • If you find that the mass still persists after having multiple aspirations, you will need to try something more invasive. Surgical options are a more definitive therapy option and with advancements in arthroscopic surgery, unsightly scars common with more antiquated procedures are no longer deterrents for patients who choose this option. Follow-up therapy in the form of steroid injections leads to no recurrence of ganglia after 2 years of follow-up in a study involving 25 patients with this ganglion. [9]

When you do wonder what the "hard lump on my wrist" could be, make sure you go to your Family Doctor as soon as possible to ensure that it is not some type of bone tumor. He should be able to tell by just a simple physical examination but if anything is uncertain, MRIs and US studies can quickly point to what could be the underlying cause.