Ganglion on the wrist
A ganglion on the wrist is a collection of fluid under the skin that connects to the joint space. Colloquially, the ganglion is also called the fuselage, but the fuselage correctly describes a bony structure. The ganglion on the wrist occurs either directly on the joint capsule or on a tendon sheath and is usually caused there by chronic irritation. A ganglion is usually noticeable as a painful swelling, and movement restrictions can also occur.
Tendonitis is common on the wrist when a lot of work is done with the hands. The development is independent of the exertion, rather it is about the frequency of the loads. Therefore, people who work a lot on the computer are just as affected as, for example, craftsmen and musicians.
If the tendinitis becomes chronic, repeated irritation occurs in the layers of tissue in the tendon sheath. This irritation provokes an increased build-up of fluid within the tendon sheath. If there is a weak point in the outer sheath of the tendon sheath, the inner layer turns inside out through this gap, creating a ganglion.
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Rheumatism is a systemic inflammatory disease that can affect many joints. For example, rheumatism on the wrist leads to joint inflammation. This inflammation is based on the immune system attacking the body's own cells. This creates a chronic stimulus to the tissue layers of the joint, and the tissue is weakened by the body's own immune system. This favors the development of a ganglion on the wrist.
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Osteoarthritis is a mainly degenerative process that can in principle occur in all joints in the body. People who work a lot with their hands, in particular, put a lot of strain on the wrists. This favors the development of arthritic changes in the wrist. In the course of osteoarthritis, the protective joint cartilage is initially reduced, and the bone is therefore exposed to increased forces. The result is irritation in the wrist. These usually increase with any kind of stress, which is why the irritation often becomes chronic. These permanent irritations can lead to an overproduction of fluid in the wrist and thus cause a ganglion.
Read more about this topic on our page Wrist osteoarthritis
These symptoms will help you identify a ganglion on your wrist
A ganglion on the wrist is mainly characterized by swelling. Depending on the type of load, this can occur on the flexor side as well as on the extensor side of the wrist. It is usually the size of a pea, but it can also be larger. Classically, a ganglion is fluid-filled and therefore feels elastic. In addition, pain in the affected area often occurs with the ganglion. These are often movement-dependent. A ganglion can also cause movement restrictions, both due to pain and mechanical blockage.
Pain is the main symptom of a ganglion on the wrist and, in addition to the typically occurring bump, is the most important indication of the origin of the symptoms. As a rule, the pain occurs around the ganglion; some of it can radiate into the hand or forearm. The ganglion is also very sensitive to pressure.
Restrictions in movement that are caused by the ganglion are often pain-related. If the ganglion is on the extensor side of the wrist, affected people experience pain especially when the hand is overstretched. In contrast, a ganglion on the flexor side mainly causes pain when the wrist is flexed.
If the ganglion becomes particularly large, it can also press on important nerves and vessels that run along the wrist. Vascular constrictions lead to reduced blood flow to the hand and fingers and can thus cause tissue damage that causes pain. If the nerves are compressed by the ganglion, the typical nerve pain and abnormal sensations occur. Tingling or numbness are typical symptoms when the nerves are affected. On the flexor side of the wrist in particular, the ganglion can constrict various tendons and muscles and thereby trigger painful restrictions on movement and reduced strength.
The ganglion on the wrist manifests as a distinct bulge or swelling. Displacement of fluid from the joint space into the ganglion can cause the ganglion to swell. When the hand moves, the joint space is narrowed, which displaces the fluid. This is pressed into the ganglion by the connecting stalk, the ganglion enlarges. If the hand is brought back to the starting position, the ganglion is reduced in size again. However, over a longer period of time, a ganglion can also increase in size overall. This increase in size is caused by further stress on the wrist.
Find out more about the topic: Bump on the wrist
The diagnosis of the ganglion on the wrist is usually instantly recognizable. The physical examination can make the suspected ganglion diagnosis based on the location and shape of the swelling alone. In addition, it can be tested whether the skin can move over the ganglion.
A laboratory examination of the fluid from the ganglion can confirm the diagnosis. To do this, the ganglion is punctured and fluid is drawn off through a needle. In the ultrasound one tries in particular to prove that the ganglion is filled with fluid. Only rarely is it possible to depict the stem. In principle, the diagnosis of the ganglion can also be made directly during an operation. In rare cases, an X-ray is taken of the affected finger to rule out a bony cause of the swelling.
The most important component in the therapy of the ganglion on the wrist is the immobilization of the joint. This usually results in a regression of the swelling, but the ganglion often reappears when the wrist is again stressed. Upon recurrence, the ganglion can be massaged, which forces the fluid back into the joint. In addition, one occasionally tries to burst the ganglion.
If the fluid cannot be pressed out, a ganglion puncture can be performed. The fluid is withdrawn from the ganglion using a syringe. Surgical removal of the ganglion is usually only used when conservative therapeutic measures fail.
Puncture of the ganglion is done with a syringe and needle. The needle is inserted into the ganglion on the wrist and the fluid is then withdrawn. In most cases, the entire liquid is withdrawn for therapeutic purposes during the puncture. However, the liquid can then be examined in the laboratory so that the puncture also serves diagnostic purposes. It is hoped that a puncture will completely heal the ganglion, but it must be expected that every second punctured ganglion will return and must be treated again.
Can you tape that?
A ganglion on the wrist often arises on a tendon sheath and is triggered there by an overload. This overload leads to chronic irritation, which promotes the development of a ganglion. In the acute stage of the ganglion it is not recommended to tape it, a splint is usually the more sensible treatment option. However, the formation of the ganglion on the wrist can be prevented by relieving the tendons and thus also the tendon sheaths by taping.
A splint is used for immobilization, which is part of conservative therapy of the ganglion. Since the ganglion on the wrist is due to excessive stress on the joint, the ganglion should be treated with immobilization. Often a ganglion regresses when a splint is worn, but recurrences often occur, that is, the recurrence of the ganglion when the affected hand is used again and the wrist is again subjected to stress.
When is an operation necessary?
An operation for the ganglion on the wrist is usually only considered if conservative treatments do not lead to the desired long-term success. In addition, people who work a lot with their hands and fingers are operated on early. Sometimes the wishes of the person concerned also play a role. After a few frustrating conservative attempts at therapy, one can decide early on to have an operation.
The risks of ganglion surgery are mainly due to the structures around the ganglion. During the operation, the vessels and nerves that run around the wrist can be injured. Vascular damage leads to bleeding and in the worst case can cause permanent circulatory disorders.
Nerve lesions lead to loss of sensation, numbness and tingling. The motor function of the hand can also be impaired. The motor disorder also occurs with injuries to tendons and muscles. All of these risks are rare. Typical symptoms such as pain, wound healing disorders and bruises are more common. An allergic reaction to the anesthetic is also possible.
Procedure of the operation
The operation of the ganglion on the wrist can be performed under local or arm anesthesia. Most surgery is endoscopic, as only small incisions have to be made for the instruments. First, the access to the ganglion is exposed, then the ganglion is carefully cut out of the tissue. In order to protect the many tendons, nerves and vessels as well as the capsule, you have to work very precisely. Then follow the stalk up to the joint capsule, tie it off and remove the ganglion completely. As a rule, the wrist is immobilized after the operation.
Sick leave after the operation
After an operation of the ganglion on the wrist, a longer sick leave of several weeks is recommended. Especially if people who work a lot with their hands are affected, downtime of up to two months can be expected. This is the only way to prevent an early renewed overload. However, most people can go back to work after a few weeks.
What to do if the ganglion has burst
The bursting of a ganglion on the wrist is often accidental and is described by many as very painful. However, in this case there is nothing to worry about. The fluid that leaks from the ganglion is absorbed by the body within a few days. However, the pain usually lasts for the period in which the fluid is still in the tissue.
The bursting of the ganglion is often even used as a treatment approach. Even if it does not always succeed, in some people this can lead to a cure for the symptoms. However, recurrences are not uncommon. One reason for this is probably that the stalk is retained when the ganglion bursts. Through this there is still a connection between the joint space and the space of the ganglion. If the defect that was caused by the burst closes again, fluid can collect there again and a new ganglion develops. After the ganglion has burst, the wrist should still be observed as it can cause inflammation.
Usually a ganglion persists until it is treated. Therefore, the duration is largely dependent on the time of therapy. Overall, ganglia are harmless, so there is nothing to worry about, but people can still suffer from a ganglion on the wrist. The prognosis is characterized by the high rate of recurrence, so that many people have to deal with the recurrent ganglion on the wrist for months and years.