There’s no proof that repetitive stress on the hands and wrists are the cause of ganglion cysts — benign, fluid-filled lumps — in those areas. But given the number of nail techs who develop them, the connection seems likely.
When a fluid-filled mass the size of a large marble appeared on the base of his wrist years ago, nail technician Jerry Cook immediately went to the doctor’s office to have it checked. Though it sometimes causes discomfort — but not any pain — several doctors told Cook they didn’t want to remove it surgically. They told him it was a ganglion cyst. Because it was harmless, the suggested the best thing to do was to wait and see if it would disappear on its own.
First described by Hippocrates as a “knot of tissue,” a ganglion cyst is a ballooned sac filled with jelly-like fluid. They are usually found on or around the wrist, or on the base of the finger. Ganglion cysts are found about three times more often in women than men. People of any age can get them, but about 70% of occurrences happen between the ages of 20 and 40. The cysts can come in groups or in singular form, ranging in size from a millimeter to three centimeters across.
While many ganglion cysts disappear without medical treatment, Cook’s has been lingering for 12 years.
If you’ve heard that dropping a large book on the cyst can get rid of it, you’ve heard right. In the old days, these lumps found on the hands and feet were referred to as “Bible cysts” because people used to drop the biggest book (at that time, the Bible) on them to get rid of them.
“I had one client tell me her husband has always taken a thick phone book and hit the cyst real hard to bust it, and it goes away,” says Texas-based Cook, who works at both Tans and Hands Beauty and Fitness Center in Henderson and CS Cutting Company in Longview. Though he hasn’t tried it, many nail techs swear the technique has worked for them.
Doctors don’t recommend the book trick, however, because it can cause serious damage to your hands or wrists, says Dr. Gary Pess, a hand surgeon with offices in Central New Jersey. “It can cause pain, a fracture, or even damage to the surrounding tissue and ligaments,” he says.
WHY DO THEY APPEAR?
Understanding the symptoms and possible causes of ganglion cysts will give nail techs options for deciding what to do with the lumps, but researchers say there aren’t any proven preventative techniques.
The most common pre-cyst symptoms are pain, stiffness, or swelling in the area. Repetitive use, stress, trauma, and arthritis are common similarities among Dr. Pess’ ganglion cyst patients.
The tendons are wrapped in a covering that secretes a lubricating, nourishing fluid called synovia. When you move your hand, each tendon slides inside its sheath. Each joint also has a lubricating cover around it called a joint capsule.
Ganglion cysts are filled with the gelatinous synovial fluid, like the fluid that lubricates the joints. Dr. Pess compares the fluid to the oil that lubricates an engine. When the oil (fluid) appears to be leaking, it’s a signal that you should get it checked out by a mechanic (doctor).
One theory for ganglion cysts is that repetitive stress on a joint causes the joint capsule to develop a “blowout.” Joint fluid then flows into the balloon through a two-way valve. Over time, the two-way valve often becomes a one-way valve, causing the cyst to become increasingly large since fluid flow is restricted to one direction. The cyst wall is formed by surrounding tissue, or collagen fibers.
The fibrous sacs are mostly just unsightly, but can sometimes press against nerves and blood vessels to cause discomfort, pain, tingling, or even loss of feeling in the hand and fingers.
As some nail techs can attest to, the cysts simply go away on their own; however, doctors recommend that you get them checked for a proper diagnosis. You should seek medical advice when “any mass is present that doesn’t belong there, if a mass is growing rapidly, or if a mass is associated with other symptoms,” says Dr. Pess.
Most ganglion cysts have a defining characteristic of being translucent, explains Dr. Pess. That means if you can shine a light through it, it’s more than likely a ganglion cyst.
DRAINING THE CYST
Massage can also help reverse the flow of the fluid back into the joints or tendons after a ganglion cyst has appeared. Most hand doctors will recommend a night splint — keeping the cyst immobile overnight may cause it to pop.
When a cyst doesn’t go away, a common treatment involves the insertion of a large needle into the cyst in order to suck out the gelatinous material. Some physicians also follow that treatment with shots of a corticosteriod — a class of drugs that fights inflammation — to shrink the sac. The procedure, called aspiration, takes only a few minutes and can be done in your doctor’s office. Aspiration also confirms to doctors that the cyst is a ganglion (if fluid comes out) rather than another type of mass. The lump could be a number of different things such as a giant cell tumor, a sebaceous cyst, or lipoma, a benign tumor composed of fatty tissue. This technique, however, cannot guarantee that the cyst won’t return. Dr. Pess says there’s a 30%-60% chance of recurrence.
Be aware that cysts appearing inside the wrist below the thumb are not good candidates for aspiration. They usually lay too close to the radial artery, a major blood vessel going into the hand, and any damage to this vessel may compromise circulation to the hand.
SURGERY CAN GET RID OF THEM
If a ganglion cyst resists all other treatment, it can be removed by surgery done with a general anesthetic. Usually, the cyst works its way to the layers just below the skin, so the surgeon must work all the way down the stalk of the cyst to where it reaches into the tendon or joint capsule to get the best results. In general, the surgery only takes 10 to 15 minutes, and gives patients more reassurance that the cyst won’t reappear. With surgery there is a 5%-15% recurrence rate.
Some physicians give patients slings or casts after surgery. Dr. Pess recommends that the patient try to move her wrist as soon as possible after the surgery to prevent stiffness. Though side effects of the surgery are rare, they include infection and scarring where the incision was made. Researchers predict an 85%-95% cure rate, with both aspiration and surgical techniques. If you ever come across one, keep in mind that there’s a good chance you won’t have to live with it forever.