You are reading Hand and wrist cysts, when is surgery needed?


Hand and wrist cysts, when is surgery needed?

January 1, 2018


A cyst can form in different parts of the body, including hands and wrists. In some cases, it is only an aesthetic problem, but in others, the presence of a cyst can limit the functionality of the hand and make it necessary to undergo surgery. You should never rely on DIY treatments, as explained by Dr. Luciana Marzella, Asistant of the Operating Unit of Hand surgery at Humanitas.


What are cysts?

Cysts are not all the same: ‘The cysts of hands or wrists – explains the specialist – are localized gatherings of synovial fluid. They are bumps that can create aesthetic as well as functional discomfort if located in an area that impacts movement. Cysts can be paratendinous when they are created by inflammation of one or more tendons or joint cysts when the origin is within a joint’.

‘Often, joint cysts are secondary manifestations of a ligament lesion or an alteration of the joint, as occurs in the mucoid cysts that form on the dorsal surface of arthritic joints. Therefore, it is important to perform an ultrasound as well as an x-ray of the hand or finger affected by the cyst’. Therefore, among the predisposing factor we find ‘ligament hypertrophy, lesion of a ligament, arthritis or tendinitis’.

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No independent diagnosis

In the presence of an alteration that may lead to the diagnosis of a cyst, you should always go to the doctor: ‘The suspicion of cysts must be subjected to a diagnosis by a specialist, the patient can’t self-diagnose it – underlines Dr. Marzella – because it can happen that these are pathologies of different nature confused for cysts (such as lipomas, benign or malignant tumors of various type). Therefore, if there is a clinical suspicion, or a different formation is found from the gelatinous liquid that constitutes the cyst during intraoperative activity, a histological examination that allows the definitive diagnosis of the removed substance is carried out’.


How should you intervene?

Surgery won’t always be necessary: ‘If the cyst is not related to any pathology but it was formed due to a traumatic event or a tendinitis that resulted in hyper production of synovial fluid with subsequent resolution of the problem and disappearance of pain, it may only be an aesthetic problem, therefore intervention is not essential. In many of these cases it spontaneously reabsorbs itself. However, if it has been present for some time and it is associated with pain and functional limitation, it can be removed surgically after performing preoperative tests’, recalls the expert.

‘Cysts should never be vacuumed or punctured, because they can cause deep joint infections. If you decide to undergo treatment, it is better to get an open or arthroscopic surgical removal. Arthroscopic removal is also associated with a direct evaluation of joint surfaces and a more correct diagnosis of the origin of the cyst’. In any case, ‘regardless of the surgical technique, – concludes Dr. Marzella – cysts have a 30% recurrence rate, which increases if they are associated with other diseases’.

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