A hard knot under the skin, often plainly visible as a distortion in the skin (mine looked and felt like a protruding bone). Inside, the cyst is filled with a clear, jelly-like fluid. The origins of ganglion cysts are currently impossible to isolate; some are probably spontaneous while others may result from trauma. They most commonly occur between the bones of the wrist (on the top) and at the base of the finger. Most are benign, cause no pain, and will spontaneously disappear. Others, especially those in the wrist, are very painful and can cause permanent damage by forcing apart the bones or pressing against the nerves (accelerating or causing carpal tunnel syndrome). Initial treatment is usually aspiration--using a large needle to draw out the fluid in hopes that the cyst will shrink and disappear. However, many recur after this, and surgery may be needed to cut out the cyst and its stalk. This is a fairly delicate surgery and requires either a nerve block along with a sedative, or general anesthetic. Recovery period for wrist surgery is six to eight weeks. Unfortunately, 30% recur after the initial surgery.

PS The recovery period is way off. Two years later, mine still hurts with some frequency. Phooey.

The story of a wrist

About a half-year ago, I started to have trouble with my right hand. This started me down a moderately long road which landed me with surgery, and it's not over yet.

My current job, though mostly desk/computer related, occasionally requires extremely heavy lifting. There came a day in which I had to load three carts. Each cart's load probably weighed well over 1000 pounds, though most individual components weighed 45 to 120+ pounds. At the end of the day, I noticed that my right wrist was hurting. I ignored it since I regularly get aches and pains, not to mention spectacular bruises, from slinging things around at work.

This happened a number of times. I'd have a day with unusually heavy lifting, and notice that same, localized pain in my right wrist. I noticed the pain when I was lifting or shortly after I had lifted something. As time went on, the duration of pain extended to a few hours past exertion.

Eventually I started to take more notice of the problem. One day, I noticed my wrist looked a little "mushy" or swollen, and it ached. The mushiness went away the next day, and I (stupidly) once again thought nothing more of it, since it had gone away.

Then came the day when that mushiness did NOT go away, and developed into a nice bump. Finally, I went to my Human Resources person and got a referral to the doctor my company uses on an 'emergency' basis. That dingbat told me that since there was (at that specific moment in time) no pain, logically there must not be any injury. (Hello! I think she must have failed Neurology 101!) A rather heated exchange of words then ensued, and I successfully acquired a referral to a hand surgeon for a second opinion.

The hand surgeon diagnosed a ganglion cyst and put me on a prescription for ibuprofen: the equivalent of four Advil, three times a day. Fortunately my stomach is in good shape and was able to cope. I soldiered through three months of ibuprofen, during which time the size of the lump varied from almost going away to getting larger than it had ever been, then receding again.

At the end of the three months, I gratefully stopped taking the ibuprofen (and suffered a bit of backlash from that, in terms of increased headaches and general body pain.) I resigned myself to live with the cyst, since I knew cysts often remain for life.

Some time went by. I was not given any dispensation at work re: heavy lifting, so I kept lifting. Eventually, the cyst got larger, about 1.25 inches across and half an inch high, located approximately over the base of the second metacarpal on the back of my right hand. Worse, it started to hurt quite frequently. Sometimes I felt the pain where the cyst itself was, sometimes it was on the palm side of my wrist, sometimes down into my fourth and fifth fingers, and once, horribly, in my elbow. There was one morning when it hurt so badly that I would have gone straight to the emergency room if I could have gotten out of bed, but I couldn't move even enough to reach out for my cell phone.

I went back to the hand surgeon at that point. He took one look at the cyst and said "That has to come out." The pressure inside the cyst was affecting the nerves passing through my wrist into my hand... not a good thing. So, last Tuesday I went to outpatient surgery, went under a general anaesthetic, and out the cyst came. It's been a while since I've had surgery. I was pretty impressed; I got a thank you card from the whole team who cared for me, pre-op to surgery and through post-op. (They must really be concerned about malpractice these days.) I was told later that the cyst had been rather firmly adhered to the inside of the joint capsule.

Post-surgery, I've been taking antibiotics and painkillers. My forearm is wrapped up halfway to my elbow in thick cotton batting and an ACE bandage, and I'm under strict orders not to peek. I've discovered the joy of showering with a trashbag over my arm. (Hint: Always keep your fingers pointing to the ceiling, and raise your elbow shoulder-high.) Even right after I came home from the surgery, I was able to type (albeit a bit woozily), and in fact my surgeon encouraged me to use my hand and fingers as much as possible; he said it would be good therapy, and I agree. I went back to work this Monday, on light duty, and while it caused a bit of extra pain and I was slower than normal, I was able to do my computer and phone work.

This little adventure has taught me a few things. I did some cooking ahead of time, plus chopping up things like onions, etc., for freezing. I can still use my hand, but chopping hurts, so that preparation in advance has let me cook more, now, than I would have been able to otherwise. Also, don't absently smack a bug when you've just had surgery on your hand...NOT a good idea!

My stitches are due to come out next week. I'm told that there's a 5% recurrence rate for ganglion cysts. I sincerely hope this is a done story.

Update: January 17, 2005

My stitches are long since out. The incredible sensation of actually washing my right hand that first time after so long nearly made me faint (literally!) with pleasure.

It wasn't quite over, though. I was left with hypersensitivity ranging from my first two fingers (proximal phalanges only) to halfway up my forearm, and a nasty, humped up looking scar. Anything that touched any of that area on my hand/arm, even gently, caused instant and severe pain. I ended up taking painkillers for far longer than I wanted to, as a result.

For a few weeks after the stitches came out, I kept a 2-inch wide reusable self-adhesive fabric bandage wrapped around my hand and wrist. (It helps to cut a slice in the wrap to hook your thumb through.) This served several purposes:

  1. Constant contact was more comfortable to the hypersensitive areas of my skin than interrupted/chance contact.

  2. Its presence helped remind me not to absently attempt to lift something heavy.

  3. It helped to prevent people from randomly banging into me or asking me to help pick up or carry heavy items.

  4. It (usually) prevented the manly men I do business with from trying to set a hand-crusher handshake.

Over time, the humping of the scar has relaxed dramatically and the area actually looks reasonably good, now. (I still want to look into scar-reducing creams or films, though.) The zone of hypersensitivity has shrunk over time, as well, and is now located over the scar itself and just distal to it, which is what I expected. The surgeon told me on a followup visit that I should expose that area to as many different texture sensations as possible (for example, brushing it lightly with a scrubbie pad, et cetera) to further the desensitization process.

I'm officially back on full lifting, but I still avoid it when possible. It usually doesn't hurt, but I'm a little paranoid about it.

Update: June 4, 2005

My hand is back to normal, and has been for quite some time now.

The hypersensivity is gone, for which I am very grateful. I think I may have some extremely slight sensory loss right over the scar itself, but I can barely detect it. I was warned that I might have some decreased sensation in my fingers, but that didn't happen.

I never did investigate the scar-reducing creams. The raised area that worried me so at first has completely flattened out, and while you can see, faintly, where the sutures were, the incision is less noticeable than a natural fold in the skin of my wrist about an inch and a half (3 cm) away.

Two things I forgot to mention which might be of interest to someone facing surgery for a ganglion cyst:

  1. My surgeon told me that there were two ways to approach the removal of the cyst: Lay the skin open, or use arthroscopy. I asked him which one he would choose if it was his own wrist. He said, open it, so that's what I went with.

  2. I had a choice between local and general anaesthetic. He said he'd rather have me under, and I felt the same way.

The most amusing outcome of this adventure is that while I'm now happily tossing 80 pound boxes around again, if one of the store managers sees me doing it, they'll take the box out of my hands and finish loading the whole cart, themselves. Clearly, my ganglion cyst was costly to them. Just as clearly, they don't care that much, though, or they would have put me on restricted lifting...which they have not.

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