FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

GANGLION CYST MIGHT BE DUE TO BANQUET SERVER’S OCCUPATION

Question: I'm a 34 year-old banquet server who is one of many at my hotel banquet department who has developed a wrist ganglion cyst on the right hand. I've been in this business for 5 years. In this particular hotel we press 35-45 lb service trays and walk up to 1/8 mile one way. No other facility any of us has worked at has such a requirement. It would seem that someone has conducted a study on this industry and shown some sort of correlation to cyst. Have you heard of anything?

Answer: Ganglion cysts are the most common growth in the wrist and hand. These are commonly found on the top of the wrist (dorsum), but can also be found on the palm side of the hand at the base of a finger or the underside of the wrist, close to the thumb. They are always benign.

A ganglion cyst is a fluid-filled sac that arises from a nearby joint or tendon sheath. While the cause is not really known, one theory is that damage to a tendon sheath or joint allows fluid to leak out and form a cyst. What is known is that they are more common in women than men, and are common in gymnasts, who frequently apply stress to the wrist. Strenuous activity to the affected joint can cause it to increase in size. So it does appear that physical stress -- as you experience in your job -- may sometimes be a causative factor. Also, it may be of interest to you to know that when a joint with a ganglion cyst is rested, it will typically decrease in size.

Most often, ganglion cysts are painless and cause no problems, but they may be unsightly. Occasionally they cause pain when moving the affected area. It is not uncommon for them to disappear on their own, but some have to be drained or surgically removed.

Generally it is easy to diagnosis a ganglion cyst by its classic location on the dorsum of the wrist. If the cyst is large, your physician may shine a light through it -- a procedure called transillumination -- to prove that it is a fluid filled growth. Sometimes an MRI is done to differentiate a ganglion cyst from an arthritic lesion, especially when the lesion appears on the palm of the hand. Some physicians will drain -- aspirate in doctor lingo -- the cyst to both diagnose and treat it. However, there is a 50 percent recurrence rate when a cyst is aspirated.

Surgery is another treatment for ganglion cysts and is more reliable than aspiration in preventing recurrences. While aspiration can usually be done in a physician’s office, complete removal is best performed in an outpatient surgical setting.

By far, the most common treatment is observation. Unless a ganglion cyst is causing a great deal of pain or impairing function, there is no need to remove it. Occasionally, wearing a wrist brace can help decrease the size of a cyst.

So here it is in a nutshell: Consult with your physician to confirm the diagnosis of any new lump. Follow treatment advice. If it is a ganglion cyst, rest your wrist or hand as much as possible. Avoid activities that strain the wrist or hand. Promptly report any changes, such as dramatic increase in size, development of pain, or decreased function in the affected area. Don’t be surprised if you wake up one day and it is gone.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.