Pan Meds Post-Wrist Cyst Removal: Are They Necessary?

Ganglion cysts are fluid-filled lumps that usually develop in the wrist, hands, ankles, or feet. They are noncancerous and harmless, but they can be painful and restrict movement. While some cysts do not need treatment, others may need to be surgically removed. After the surgery, doctors usually prescribe medication for pain management and suggest elevating the hand and using ice packs to reduce swelling and pain. They may also recommend anti-inflammatory medication.

Non-surgical treatments for ganglion cysts

In most cases, ganglion cysts are benign and do not require treatment. Doctors often suggest monitoring the cysts, as they may disappear on their own—up to 58% of ganglion cysts on the wrist can go away without treatment. However, if a cyst is causing pain or restricting movement, there are several non-surgical treatment options available.

Bracing or Splinting

A doctor may recommend wearing a brace or splint to limit the movement of the affected joint. This can help reduce discomfort and even make the cyst disappear. As pain decreases, a doctor may prescribe exercises to strengthen the joint and improve the range of motion.

Aspiration

If a cyst is causing severe pain or limiting daily activities, a doctor may recommend draining the fluid from the cyst through a procedure called aspiration. During this procedure, the area around the cyst is numbed with a local anaesthetic, and the cyst is punctured with a needle to drain the fluid. Aspiration can shrink the cyst, but it may not eliminate it completely, as the cyst's connection to the joint or tendon sheath (its "root") remains and can allow the cyst to regrow.

Steroid Injections

In some cases, doctors may inject steroids into the cyst after draining the fluid to help prevent recurrence. However, this approach has shown variable success rates, and there is a risk of potential complications such as subcutaneous fat atrophy and skin depigmentation.

Hyaluronidase Injections

Hyaluronidase injections can be used to depolymerize the hyaluronic acid present in the cyst. This approach has been reported to have a high cure rate, but the success rate has been inconsistent, and there is a risk of allergic reactions.

Sclerotherapy

Sclerotherapy involves injecting a sclerosant into the cyst sac to damage the intimal lining and cause fibrosis, reducing the recurrence rate. While initial studies showed high success rates, subsequent research indicated that sclerotherapy may not be effective in treating ganglion cysts due to the communication between the cyst and the synovial joint, which could lead to potential damage to the joints and tendons.

Transcutaneous Electrocauterization

This technique uses electrocautery to cause ganglion sclerosis. It has shown favourable results but has not been widely adopted.

Surgical procedures for ganglion cyst removal

The specific surgical procedure will depend on the location of the cyst. For cysts on the back of the wrist, a crosswise cut is made, and the cyst, including the stalk, is removed. Surgeons must take care to avoid damaging the ligament in the middle of the wrist.

For cysts on the underside of the wrist, near the palm, the procedure is more complex. Surgeons must carefully work around the radial artery and a major nerve in the wrist. Incomplete removal can lead to the cyst returning.

Before surgery, doctors may mark the incision location with a line drawn above the cyst. During the procedure, the treatment area is numbed, and the doctor cuts along the line, identifies the cyst, and removes it, along with its capsule or stalk. The incision is then stitched closed to allow healing.

After surgery, doctors usually prescribe medication for pain management and may suggest anti-inflammatory drugs. Elevating the hand and using ice packs can also help manage pain.

Recovery after cyst removal

Recovery after a ganglion cyst removal is a relatively quick process, but there are a few important things to keep in mind to ensure a smooth and safe recovery.

Rest and Elevate Your Hand

In the first few days after surgery, it is important to rest your hand and wrist as much as possible. Elevating your hand above your heart can help reduce swelling, and using ice packs can provide additional relief.

Limit Hand and Wrist Movement

It is crucial to limit movement of your hand and wrist for the first few days to minimise pain and avoid irritating the removal site. Minimal, non-repetitive activities, such as writing or carrying light objects, are generally considered safe.

Follow Your Doctor's Instructions

Your doctor will provide specific instructions regarding your recovery, including when you can resume normal activities and any exercises you should perform to regain movement, strength, and grip in your wrist and hand. It is important to follow these instructions carefully.

Manage Pain and Swelling

Localised pain after surgery can be effectively managed with numbing medications, over-the-counter pain medications, or prescription pain medications. Swelling can be treated with ice packs and will typically subside within a few days to weeks.

Keep the Area Clean and Dry

It is important to keep the surgical site clean and dry to prevent infection and promote healing. Your doctor will advise you on how long to keep the bandage in place and when it is safe to shower or bathe.

Be Aware of Potential Complications

In rare cases, infection or other complications may occur after ganglion cyst removal. Contact your doctor immediately if you experience any signs of infection, such as increased pain, swelling, warmth, redness, or pus draining from the site.

Recovery Timeline

The recovery timeline for ganglion cyst removal is generally two to six weeks, although individual experiences may vary. Most patients feel much better within the first few days, but it takes the full recovery period for the hand and wrist to regain their full range of motion and functionality.

Risks of cyst removal surgery

As with any surgery, there are risks associated with cyst removal surgery. This is true whether the cyst is on your wrist, hand, ankle, foot, or elsewhere on the body.

Cyst removal surgery is usually carried out as an outpatient procedure, meaning patients can go home the same day. The procedure typically involves four steps: administration of local anaesthetic, cutting into the skin, removal of the entire cyst, and stitching and repairing the skin.

• Infection: There is a risk of infection after cyst removal surgery. Your doctor may prescribe antibiotics to prevent the infection from spreading.
• Allergic reaction: You may experience an allergic reaction to the anaesthesia or the stitches used during the procedure.
• Scarring: Surgical removal of the cyst will result in a scar. The size of the scar will depend on several factors, including the size of the cyst.
• Sensitivity: You may experience sensitivity or discomfort around the scar tissue.
• Nerve damage: There is a risk of damage to the nerves, tendons, or ligaments surrounding the cyst. In the case of ganglion cysts on the wrist, this could include damage to the median nerve or the radial artery.
• Loss of movement: In some cases, patients may lose the ability to move the affected joint normally after surgery.
• Recurrence: Even with surgery, there is a chance that the cyst may reoccur.

Most people heal quickly and without difficulty after cyst removal surgery, but it's important to be aware of these potential risks.

Post-surgery instructions

After the surgery, your hand and wrist will be covered in a dressing and placed in a plaster splint that you will need to wear for five days. The splint will protect the incision site and help reduce swelling. You may experience some numbness or tingling in your fingers due to the local anaesthetic.

Pain management:

You will be prescribed narcotic pain medication to be taken as directed. It is important to stay on top of your pain management and not let the pain get worse before taking medication. Medication for nausea will also be provided.

Caring for the wound:

After the first five days, you can remove the splint and dressing. Cover the incision with a small bandage to prevent it from catching on clothing. Do not apply any ointment or lotion to the wound. You can shower without covering the incision, but do not soak your hand in a bathtub, hot tub, or swimming pool.

Reducing swelling:

You can use an ice pack for up to 20 minutes at a time throughout the day to help reduce swelling. Be sure to place a thin cloth between the ice pack and your skin. Keep your hand elevated as much as possible to reduce pain and swelling.

Activities:

You may use your hand for light activities such as getting dressed or typing. Do not lift objects heavier than a soda can (about 1 pound or 0.45 kg) until your sutures have been removed. Avoid any heavy lifting or repetitive activities for at least four weeks after surgery.

Suture removal:

Your sutures will be removed approximately 10-14 days after surgery. A hand therapist will help assess your progress and teach you exercises to reduce scarring and improve hand strength and range of motion.

Driving:

Do not drive if you are taking narcotic medication. Once you are no longer taking this medication, you may drive when you can comfortably grip the steering wheel with both hands.

Frequently asked questions