Rhythmic Physician: Bumps In The Night

Rhythmic Physician: Bumps In The Night

It is always scary to discover a bump or mass where there was never one before. The development of a mass around the hand or wrist is quite common, especially when the bump is a ganglion cyst.

Ganglion cysts are fluid-filled bumps or masses (non-cancerous cysts) that most commonly develop along the tendons or joints of your wrists or hands. They may develop suddenly or gradually over time, and the exact cause is unknown. Ganglions grow out of a joint, similar to a bubble on an inner tube, and commonly occur when the tissue that surrounds a joint or a tendon bulges out of place. The fluid within the cyst is a clear, thick, sticky fluid similar to that found in joints or around tendons.

The regular, repetitive hand and wrist movements required in drumming place drummers at risk for these cysts. Other risk factors for developing ganglion cysts include any injury to the joints or tendons, or osteoarthritis in the hands or wrist. Osteoarthritis can increase fluid within the joints, which can then leak into the tendon sheath and accumulate in an existing cyst.

In most cases, ganglion cysts are found on the top of the wrist, cause no pain, require no treatment, and often disappear on their own. In many cases, I recommend a wait-and-see approach before exploring more aggressive treatment. However, if the ganglion cyst is painful or interferes with joint movement, other options become necessary.

Ganglion cysts were once known as “Bible cysts,” referring to their mode of treatment, which was to hit them with a Bible or other heavy object to burst the cyst. Treatment of these common cysts has evolved considerably over time.

Since repetitive activity can cause the ganglion cyst to increase in size, a short course of immobilization by wearing a wrist brace may help the cyst to decrease in size. As the cyst shrinks, pressure is released, relieving pain.

The cyst can also be aspirated (drained of fluid) by inserting a needle into it. However, ganglion cysts may frequently return after aspiration. Aspirations can be repeated, and multiple aspirations may eventually put an end to the recurrence of the cyst. I also recommend a steroid injection into the empty cyst cavity after aspiration to reduce the recurrence rate. If the ganglion cyst recurs, and if significant pain or painful, difficult joint movement continues, surgical removal is recommended.

As drummers, it is imperative to maintain pain-free motion of the hands and wrist to perform effectively. When a problem develops, neglecting it can lead to loss of function. When in doubt, get it checked out!

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