HAND OR WRIST GANGLION (Synovial Hernia; Synovial Cyst)
HAND OR WRIST GANGLION
(Synovial Hernia; Synovial Cyst)
DESCRIPTIONA hand or wrist ganglion is a small, usually hard nodule lying directly over a tendon or a joint capsule on the back or palm of the hand or on the back of the wrist. Occasionally the nodule may become quite large. The back or palm of the hand, the tendon sheath (a thin membranous covering to the tendon), and any of the joint spaces in the hand are involved.
Appropriate health care includes:
Doctor's care for diagnosis and possible injections of local anesthetic or cortisone.
Surgery (usually). Surgery will be conducted under local or general anesthesia in an outpatient surgical facility or hospital operating room.
SIGNS & SYMPTOMSA hard lump over a tendon or joint capsule in the child's hand or wrist. The nodule "yields" to heavy pressure because it is not solid.
No pain usually, but overuse of the hand may cause mild pain and aching.
Tenderness if the lump is pressed hard.
Discomfort with extremes of motion (flexing or extending) and with repetition of the exercise that produced the ganglion.
CAUSESMild sprains and chronic sprains to a child's hand joint, causing weakness of the joint capsule.
A defect in the fibrous sheath of the joint or tendon that permits a segment of underlying synovium (the thin membrane that lines the tendon sheath) to herniate through it.
Irritation accompanying the herniated synovium, causing continued secretion of fluid. The sac gradually fills, enlarges, and becomes hard, forming the ganglion.
RISK FACTORSRepeated injury, especially mild sprains. Hand and wrist ganglions frequently occur in bowlers and tennis players and handball, racquetball, and squash players.
Inadequate warmup prior to practice or competition.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should build strength with an appropriate conditioning program and should warm up before sports.
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the child's hand and wrist.
After surgery: excessive bleeding; surgical-wound infection; recurrence if surgical removal is incomplete.
Calcification of the ganglion (rare).
Ganglions sometimes disappear spontaneously, only to recur later. Surgery is often the only treatment to guarantee cure. After surgery, allow about 3 weeks for your child's recovery if no complications occur.
HOME CAREImmediately after surgery:
If the child's wound bleeds during the first 24 hours after surgery, press a clean tissue or cloth to it for 10 minutes.
Your child can bathe and shower as usual, washing the incision gently with mild unscented soap.
Between baths, the child should keep the wound dry with a bandage for the first 2 or 3 days after surgery. If a bandage gets wet, change it promptly.
The child can take whirlpool treatments, if available, after the wound heals.
MEDICATIONYour doctor may prescribe pain relievers. Your child should not take prescription pain medication longer than 4 to 7 days. The child should use the minimum needed to control pain.
Use non-prescription drugs, such as acetaminophen, for minor pain.
ACTIVITYThe child can return to normal activity as soon as possible.
The child should avoid vigorous exercise for 3 weeks after surgery.
DIET & FLUIDS
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has signs or symptoms of a hand or wrist ganglion.
Any of the following occur after surgery:
-- Increased pain, swelling, redness, drainage, or bleeding in the surgical area.
-- Signs of infection (headache, muscle aches, dizziness, or a general ill feeling, and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.