I have a lump on my wrist - what is it?!

Wrist Ganglions: Understanding what they are, diagnosis and treatment options

Insight Hand Therapy is a Hand Therapy Clinic located on the Gold Coast, providing specific assessment, treatment and active rehabilitation for hand and upper limb injuries / conditions. Telehealth hand therapy services are also offered for those who do not live on the Gold Coast or Northern NSW, or for those who are unable to attend a face-to-face appointment. The below information is intended for general information purposes and should not substitute individualised, medical or therapy advice. Please get in contact with us directly for more information or for an appointment with an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association).

There can be a number of reasons a lump or swelling on your wrist might develop. If you have injured your wrist or fallen on the hand and there is swelling and pain, it is very important to have this reviewed to rule out any acute fracture (bone break), tendonitis (tendon inflammation), synovitis (inflammation of the joint lining) or ligament injury, and to ensure you receive the correct treatment. Wrist ganglions are one of the most common benign masses (non-cancerous lumps) that occur in the hand and wrist region. They can either be quite small (many people don’t even know they have them!) or fairly large, and can be either pain-free or can cause discomfort. They can often appear on the back of your wrist in the middle, or on the thumb side of your wrist and look and feel like a small soft pea is sitting just under your skin! 

A wrist ganglion is a cystic (fluid-like) swelling that arises from the lining of a joint or tendon sheath. The exact reason wrist ganglions develop remains unclear, but some theories suggest that they may be caused by repeated microtrauma or degeneration of the joint or tendon sheath. Their size can vary from small pea-sized nodules to larger masses that can displace surrounding structures, and can restrict movement. They can often change in size depending on the functional demands on the joint (for example, they may increase in size with lots of use of the wrist, and decrease in size with relative rest).

Assessment and Diagnosis:

The diagnosis of wrist ganglions is primarily based on clinical examination, medical history, and imaging studies. Individuals with wrist ganglions can present with pain/discomfort, a soft lump, and often limited movement in the wrist joint. Your hand therapist will review the lump and assess its size, location, mobility, and tenderness. They will also evaluate the range of motion of the joints, assess your pain and rule out other potential causes for your presentation.

Not all ganglions require imaging, and can often be diagnosed with clinical assessment alone, however ultrasound and MRI can assist to confirm the diagnosis of a wrist ganglion, rule out other conditions, and assess the size, location, and characteristics of the mass.

Treatment Options:

The treatment of wrist ganglions depends on various factors, including the individual’s age, symptoms, functional limitations, functional demands and the size and location of the mass. In general, ganglions can be managed either conservatively or surgically. It is usually best practice to manage ganglions conservatively prior to considering surgical intervention.

If the ganglion is not causing any symptoms (asymptomatic) then often no treatment is required. If the ganglion is causing symptoms, your hand therapist may advise a period of relative rest in a wrist brace or custom-made splint. Specific exercises are also provided to ensure you do not lose movement or strength in the joint, and are upgraded over time based on your symptom reduction. Pain management strategies such as the use of heat may also be recommended.

Another treatment option includes aspiration of the ganglion. Aspiration involves using a needle and syringe to remove the fluid from the ganglion, which can relieve pain and pressure, however recurrence rates can be high following aspiration.

Surgical treatment for wrist ganglions involves removal of the lump, either through open or arthroscopic techniques. Open excision involves making an incision in the skin to access and remove the ganglion, whereas arthroscopic excision uses small incisions and a camera to visualize and remove the ganglion. It is important to note that there remain moderate rates of recurrence of ganglions following surgical removal. Additionally, recovery time and rehabilitation may vary depending on the complexity of the surgery, other structures involved and the individual’s overall health status.

Wrist ganglions are common benign masses that can either be asymptotic or can cause pain and functional impairment in the hand and wrist region. The diagnosis of wrist ganglions is primarily based on clinical examination and imaging studies, and first line treatment is often conservative management with hand therapy. If you suspect you have a ganglion that is causing issues, please get in contact with us to make an appointment!