Pathology
This is a sac filled with a viscous fluid originating from a joint of the wrist or a finger, or from a tendon sheath. The most common locations are the wrist—either on the dorsal side (back of the hand) or on the side where the pulse can be felt—and the back of the joints at the tips of the fingers. The cyst usually appears spontaneously without a clear triggering factor, although some cysts may occur after trauma or be associated with osteoarthritis (wear of the joint cartilage). The cyst may be painful on palpation and during wrist movement. It is always a benign lesion.
Examination
An ultrasound or magnetic resonance imaging (MRI) may sometimes be necessary to confirm the diagnosis and determine the precise location of the cyst, particularly when it is not visible externally and remains deeper.
Treatment
Non-surgical
This is the most common treatment. When the lesion originates from the wrist, wearing a removable splint for a few days or weeks may relieve pain. After this period, the size of the cyst often decreases and it may become painless. Anti-inflammatory medications prescribed for short periods can also reduce pain regardless of the cyst’s location.
Surgical
Surgery may be necessary in some cases, but only after non-surgical treatment has failed. The procedure consists of completely removing the cyst down to its origin, whether from a joint or a tendon sheath. However, it should be noted that the recurrence rate is relatively high (7–15%). The procedure lasts about thirty minutes and is performed on an outpatient basis under locoregional anesthesia (hand and forearm). A splint is worn for a few days before allowing wrist movement. The fingers should be moved as normally as possible. The sutures are removed after two weeks (unless they are absorbable).
These procedures are usually performed as day surgery and generally do not require general anesthesia.
