Visions of spring training danced in his head, but the high school freshman was distracted and worried. How could he even think about baseball or plan on perfecting his pitch when he had that strange and painful lump on his wrist?
I examined the boy and found a small, raised, flesh-colored, rubbery mass on the back of his wrist. Though the area was not tender to touch, my patient said it did hurt with repetitive motion and he doubted that he'd be able to fully participate in preseason conditioning.
The lesion appeared to be a ganglion cyst, a relatively benign fluid-filled joint mass. Referral for this condition is usually not necessary, but pain, limitation of joint motion, or parental or patient anxiety are all good reasons to send the patient for an orthopedic opinion.
Since the teen complained of wrist pain, I urged the mother to consult a hand or general orthopedic surgeon. Though the appointment with the specialist came up pretty quickly, by the time the surgeon looked at the wrist, the pain was - of course - gone. He was able to reassure both mom and son that the mass was indeed a ganglion cyst, which was nothing to worry about and would likely resolve without treatment.
Experts at the American Academy of Orthopaedic Surgeons explain that a ganglion cyst develops from a joint capsule or tendon sheath. When the capsule or sheath breaks down or tears, fluid flows in a one-way direction into the cyst. Since the cyst arises from a joint space, it is often described as having the appearance of a "balloon on a stalk," and actually contains the same thick synovial fluid found in joints.
Ganglion cysts are more common in females, and most often affect individuals between 15 and 40 years of age, but can occur in younger children. They are typically found on either side of the wrist or at the base of a finger, though cysts can also pop up on the feet. Medical management of ganglion cysts usually involves observation. If hand and wrist symptoms are bothersome and persistent, treatment options include immobilization of the affected area and drainage, or less commonly, surgical excision of the cyst.
When a child presents with a benign appearing ganglion cyst, orthopedic specialists Drs. Angela Wang and Douglas Hutchinson encourage simple observation as the first step in treatment. In their article published in the Journal of Hand Surgery, the physicians note a high rate (64-79 percent) of resolution of pediatric ganglion cysts without intervention. Surgical treatment of pediatric ganglion cysts results in a higher rate of recurrence when compared to the adult experience, with up to 43 percent of pediatric ganglion cysts refilling after puncture or aspiration, and up to 35 percent of cysts recurring following surgical excision.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.