Wrist Cyst

What is a cyst?

It is a pocket filled with synovial fluid coming from the joint or the sheath of the wrist flexor or extensor tendons. The origin of these very common cysts remains mysterious, and we speak of a capsular disease or "mucoid degeneration".

Their frequent locations are the dorsal side of the wrist (scapholunate cyst), then the palmar side (pulse groove cyst), or the radial flexor carpi tendon.

These cysts are benign lesions, having no influence on the future of the joint, and can sometimes resolve on their own. They can occasionally become very large, up to several centimeters in diameter, even painful and bothersome, which will then motivate their possible treatment.

Some are on the contrary very small (1 to 2mm), causing pain but invisible without imaging examination.

There is no relationship between wrist cysts and osteoarthritis, and it is a pathology that can affect very young patients.

Pulse groove cyst (+), close to the radial artery. Scapholunate region cyst, dorsal (*). Capsular origin of the cyst (o)

I have a cyst, what can be done?

Above all, nothing, if this cyst is not bothersome.

Indeed, it can disappear on its own (even after several years), without a scar, and presents no particular danger. Even when large, there is no risk of it opening to the outside.

Surgical treatment

If it is regularly painful and bothersome, including outside of size changes, it can be operated on, with the intervention aimed at removing the cyst and the adjacent "diseased" capsule portion.

⚠️ To avoid: puncture or aspiration

Puncture or aspiration of the cyst should be avoided as it leads to frequent recurrences, because the cyst wall produces its own synovial fluid, and there is a risk of infection if the puncture is done in non-sterile conditions.

I'm going to have cyst surgery... what will happen to me?

It is a short procedure, under regional anesthesia, most often outpatient.

Healing

Two weeks of healing are necessary, and the hand should be used immediately to preserve mobility. Of course, a skin scar remains, a sign of the surgical intervention.

Open technique

The operation can be performed by "open technique" with an incision corresponding approximately to the diameter of the cyst. This allows removal of the cyst "pocket" as well as its implantation on the joint capsule. This is the most complete treatment, but with the largest scar. It is most appropriate for small or multilobulated cysts.

Arthroscopic technique

The operation can be performed arthroscopically, using several small incisions, allowing a camera to be introduced into the wrist and surgical tools. This technique "nibbles" the joint capsule at the cyst implantation and drains the cyst "pocket", but the latter must resorb on its own, which does not always happen completely. This technique will be especially interesting in case of very large cyst, when the incision by open technique would be very wide.

Post-operative splint

A wrist splint is worn for 2 weeks to keep the wrist at rest, but regular movements are encouraged.

Is cyst surgery risk-free?

No, of course not. Although it is a codified, routine and mastered procedure, the risk exists, as with any surgery, even if complications are very rare.

We mainly find, even if all precautions are taken:

Healing difficulties
Hematoma
Local infection
Anesthetic complications
Slight decrease in joint mobility sometimes observed from joint capsule healing

There is especially the risk of cyst recurrence (30%), which is not strictly speaking a complication, but rather belongs to the evolution of the capsular disease.

A new surgery can be proposed in the same way if it is bothersome again.

What is the risk of not having surgery?

The cyst can increase in volume or regress on its own. The only risk is that of increasing discomfort.