Painful Ganglion in both wrists? What can you do?

September 6, 2016 10:29 AM

Has anyone had this or know of someone who has and how they have dealt with it? Are there any home-remedies or anything like that, that have helped treat it or reduce the swelling/pain? (More details in extended explanation.)

I am writing this on behalf of a friend. She is 27 and has painful ganglion in her wrists. It has been painful for her for a couple of years now to the point where she can't play racket sports at all and can't write or type on a computer for more than a few hours. She has been to the doctor/NHS (UK hospital) about it several times and all they have done is say she needs to have physiotherapy for it. On her last visit there, they said that continuing with physio will not help her anymore and she could have surgery for it, but there is a high percentage that it will reoccur and that she should just take painkillers for it for the rest of her life.

posted by sockpim to Health & Fitness (22 answers total)

Has she ever just smashed it down? That's what everyone in my family has done, usually with a hardcover book. They were generally just lumpy, though, not painful to that degree, so HMMV.
posted by kate4914 at 10:32 AM on September 6, 2016 [2 favorites]

Is it possible for your friend to get a second opinion?

I had a ganglion cyst on my wrist, and my US-based sports medicine doctor said that the two main treatments were draining it with a syringe (higher chance of recurrence), or surgically removing it and "roughing up" its point of origin to discourage it from reforming.

I got the surgery last summer and it hasn't come back so far.


Frankly, I'm surprised at her doctor's reaction, especially given the pain she's in. My symptoms weren't as bad as you describe hers as being, and I still couldn't shake hands with someone without seeing stars.
posted by homodachi at 10:37 AM on September 6, 2016 [2 favorites]

Also, IANAD but her doctor's suggestion for physical therapy for a cyst baffles me. Is there some information we're missing?
posted by homodachi at 10:40 AM on September 6, 2016

Draining, surgery, and (not super recommended) smashing with a book are the treatments I know of. I had mine drained and it came back pretty promptly, but mine isn't painful so I just let it be after that. (I have heard a horror story about nerve damage from the surgery, but I can't imagine that's a common outcome.)
posted by restless_nomad at 10:43 AM on September 6, 2016 [1 favorite]

My friend who is a massage therapist gets these a lot. Her teachers taught her to smash it with a heavy book (sounds intense to me, but I guess it works). If your friend isn't brave enough to try this on her own, tell her to have the doctor lance it. They will need to get the sac out or it will reform. Depending on how deep it is, this may be more trouble than it's worth, but draining it will at least make it stop hurting.
posted by ananci at 10:45 AM on September 6, 2016 [1 favorite]

I had surgery for a group (!) of very large ganglions in my right hand more than ten years ago now, and they've never reoccurred. Prior to the surgery I had also been through PT treatments w/massage, and also draining twice.

Have the surgery. It will make a huge difference.
posted by anastasiav at 10:48 AM on September 6, 2016

I had somewhat painful ganglion cysts on both wrists as a teenage. There were certain activities that were painful or difficult to do (play violin, do pushups, bend my wrist more than a little bit downward) but it wasn't like I was constantly in pain. It didn't hurt to shake hands or write.

My GP tried both the 'dropping something heavy on it' and 'suck it up with a needle' methods and my cysts returned. I ended up getting surgery on both wrists (a couple months apart) and my left wrist is cyst-free 20-some years later. My right wrist has a small two-part bump but it doesn't bother me nearly as much as my old cysts. I still hate bending my wrist and doing planks or push-ups can still be painful if I do too many but I think my wrists are just weaker than normal.
posted by hydrobatidae at 10:49 AM on September 6, 2016

I had a large, aching ganglion cyst on one of my wrists in the past. I sometimes couldn't turn door knobs with that hand, or use it for some basic motions. I had a restricted range of motion due to the cyst.

I got it drained with a syringe twice; it took quite a while each time but both times it did come back eventually. However, both times it was an easy, basically painless procedure and I was glad I did it - the respite was worth it. There is also a small chance that a drained cyst does not come back, so it's always worth a try.

I did the doctor-prescribed physical therapy exercises to strengthen the muscles around my wrist and those didn't help. In retrospect, I probably didn't do them regularly or often enough.

What did help me, actually, was taking up rock climbing at a local gym. My grip strength (very very weak before) went up dramatically, and the cyst itself eventually just... went away. It was *awesome*. I don't rock climb anymore, but I've never had my cyst come back since then. I wholly credit rock climbing with fixing the problem.

I think you could achieve the same thing by regularly and carefully working on your grip strength. But it would definitely need to be a big, concentrated effort. You can google a lot of exercises for working on grip strength, or start out with a visit to PT to get some ideas. Or you could take up rock climbing! :)

Honestly, though, if my cyst hadn't gone away when I started rock climbing, I would have gotten the surgery eventually. It would have been worth it.

Best of luck to your friend.
posted by warble at 10:53 AM on September 6, 2016 [1 favorite]

The traditional remedy for a ganglion cyst is to wham it with a family Bible.

I'm the only Bible reader in the family, and I would be reluctant to risk my iPhone with that kind of blunt force trauma, but maybe if you got a hardcover Proust and bashed it with that?
posted by tel3path at 10:58 AM on September 6, 2016

They can be drained pretty easily, though they can recur after. I've smashed one on my husbands wrist with a very large textbook and it never came back. The book method is traditional, but doctors advise against it because you could, potentially, create some sort of secondary injury unrelated to the cyst. But, you know, I also clean my ears with q-tips, so maybe I'm just more reckless than most. I would give serious pause before considering surgery. And, I don't think physio would help at all and I'm puzzled by that suggestion.
posted by quince at 11:12 AM on September 6, 2016 [2 favorites]

Surgery worked for me. No reoccurrence.
posted by Marinara at 11:31 AM on September 6, 2016 [1 favorite]

I had one on my wrist about 30 years ago. It was not painful, but it was unsightly. I had it surgically removed. Quick, easy surgery, and it has not come back in all these years. Just get rid of it, and be done with it!
posted by merejane at 11:32 AM on September 6, 2016

I had one on an ankle and while doctors were initially hesitant to do anything about it, I kept complaining (it was an issue of shoe fit more than pain) and eventually had it drained. This was 6+ years ago and it has not reoccurred. The procedure was really simple and painless, and was done in my GP's clinic at a regular appointment. Definitely worth a shot.
posted by snorkmaiden at 12:43 PM on September 6, 2016

I had mine injected with cortisone, which didn't seem to do anything immediately after. About 3 months later I felt a weird sensation in my wrist when I was reaching for something and the cyst had popped. It has never returned. I never had the nerve to bash it with a book myself.
posted by rozee at 1:00 PM on September 6, 2016

Believe it or not, mine just disappeared on its own after about a year. Does your friend wear a wrist brace while she types or plays racket sports? My wrist brace made it possible for me to type while I was dealing with the cyst.
posted by Countess Sandwich at 1:13 PM on September 6, 2016

Surgery also worked for me.
posted by fshgrl at 2:02 PM on September 6, 2016

I had ganglions in both wrists when I was in my early 20's - one was very pronounced and the other was relatively small, but they were awful.

When I saw my GP, he suggested "Bible therapy" as above (which was interesting coming from a little Muslim doctor, but his sense of humour was extraordinary). He said that I could have surgery but couldn't guarantee that they wouldn't reoccur.

I suffered on for a year or so and managed to rupture the huge one whilst wrestling with my boyfriend. It reoccurred a couple of months later but much smaller. And then they both...just went away.

I never had the nerve to bash them with a book, but given that the pain from rupturing it was not actually that bad (a brief flash of discomfort, followed by a few hours of gentle throbbing) I probably should have tried that first rather than enduring endless aching that even pain killers wouldn't help.
posted by ninazer0 at 3:42 PM on September 6, 2016

A bunch of anecdotes about books and surgeries aren't useful to your friend.

Here is a good review of treatment outcomes.

Of note is that aspiration (draining) is successful 30-50% of the time, though it may also depend on the type of cyst. Surgery is probably better, but recurrence rates are probably under-reported, and may be as high as 40%. A lot depends on how radical the surgery is. The more radical the surgery, probably the less likely the recurrence; however, the more radical the surgery, the greater the risks.

Physical therapy was probably recommended because the cysts are sometimes, but not always, thought to be caused by over use injuries.

The traditional Bible Therapy (these used to be called Gideon cysts, named for the Bible) is only not recommended because of the possibility of hurting yourself some other way. Also, the chance of recurrence is probably at least as high as aspiration.

If they're very painful and causing her this much trouble, the thing to do at this point is to get a second opinion.
posted by Lutoslawski at 4:34 PM on September 6, 2016

So my husband had one. After some online research learned that the bible technique has the lowest rate of reoccurrence. The risk is causing some other type of injury. After considering our personal beliefs I bent his wrist over a ledge and gave it a good, hard wack with a 2nd year Calculus textbook. He said it hurt for a few seconds then was totally fine. That was 3 years ago.
posted by saradarlin at 5:13 PM on September 6, 2016

Another n for surgery worked and has not recurred for at least 13 years. Totally worth it even it does recur....
posted by Tandem Affinity at 6:20 PM on September 6, 2016

So, no one's mentioned this so far in the thread, but ganglion cysts can show up on different places on your wrist.

The common one seems to be the back (outside) of the wrist, and watching youtube videos, that seems to be the ones that (might?) respond better to being whacked with a book.

Mine are on the inside of my wrists. One healed on it's own. One keeps getting worse. I tried smacking it hard with a book, and while I didn't break my wrist, it hurt for a few days and didn't actually fix anything. :-/

A surgeon (US) tells me that the ones on the inside of the wrist, they don't like to drain, as there's some artery or vein near there that they really don't want to hit. Surgery sounds like a week of not using my wrist at all, a month of going light on it, and then supposedly fine after that, with a 10-20% chance of (lifetime) recurrence.
posted by talldean at 12:18 PM on September 7, 2016

What did help me, actually, was taking up rock climbing at a local gym. My grip strength (very very weak before) went up dramatically, and the cyst itself eventually just... went away. It was *awesome*. I don't rock climb anymore, but I've never had my cyst come back since then. I wholly credit rock climbing with fixing the problem.

I think this is a very interesting answer because:

The most commonly accepted cause of ganglion cysts is the "herniation hypothesis", by which they are thought to occur as "an out-pouching or distention of a weakened portion of a joint capsule or tendon sheath." This description is based on the observations that the cysts occur close to tendons and joints, the microscopic anatomy of the cyst resembles that of the tenosynovial tissue, the fluid is similar in composition to synovial fluid, and dye injected into the joint capsule frequently ends up in the cyst, which may become enlarged after activity. Dye injected into the cyst rarely enters the joint, however, which has been attributed to the formation of an effective and one-way "check valve" allowing fluid out of the joint, but not back in.[5]

Which means that you might expect such an outpouching of the joint capsule to increase in size, or originate, for that matter, when activity that brings the opposing surfaces of the joint closer together forces synovial fluid out from between those surfaces into the periphery of the joint capsule and stretches the outer membrane.

But rock climbing would tend to pull those opposing joint surfaces apart, and the way it makes the tendons and ligaments stand out from the arm and hand might open a channel to a ganglion cyst which was closed by being trapped under those tendons and ligaments, and those two factors working together might tend to suck fluid out of the cyst back into the joint.

So I think your friend could try exercises which gently and repetitively stretch her wrist joints and make the tendons stand out, and see whether that reduces the cysts.
posted by jamjam at 7:10 PM on September 7, 2016