Thursday, July 24, 2014

My home remedy for a volar (palmar) ganglion cyst

Age has many insults. Among the minor ones are lumps and bumps that come and go — like the Ganglion Cyst of the Wrist. These cysts are annoying, common, and weirdly mysterious.
I like the theory that at least some of them are due to a “a rent in the joint capsule … allow leakage of synovial fluid into the peri-articular tissue. Subsequent reaction between this fluid and local tissue results in the creation of the gelatinous cystic fluid and the formation of the cyst wall”. In plain language, some tear in the joint capsule causes joint fluid to leak and the tissue around the join tries to seal the leak with a thick fluid plug.
These usually happen on the back of the wrist, but I’ve had two on the palm (volar) side of my right wrist. One showed up in 2012 and another 2 years later. Oddly enough, I don’t recall seeing many of these during the five years I was a country GP. I’ve probably forgotten em.
When it first happened I researched the medical literature. I didn’t like any of the options - particularly for palm-side (volar) cysts. Surgery is expensive, prone to complication, and not terribly effective. Aspiration (puncture skin, try to suck out thick fluid) did no better — though it can work better on the dorsal side. It wasn’t clear splinting did anything, and smashing the cyst with “a bible” is problematic for dorsal cysts and ineffective for ventral. The best option seemed to be to do nothing and wait. Except that a volar cyst is a real pain when typing - which I do most of the day.
So I made up my own treatment. I taped a coin over the cyst and wrapped it with tape. Something like this:
Which work great for a day or two, until elastic tape and skin traction made for a nasty burn-like dermatitis. Good thing I was experimenting on myself. So then I went on to make a soft fabric strap out of “Get-A-Grip” multi-use velcro straps …
Ganglion Cyst Splint 3
and I taped a quarter to the strap:
Ganglion Cyst Splint 4
No more nasty skin traction (the transparent tape on the top right is tegaderm, treating my iatrogenic dermatitis/burn).
When I did this in 2012 the cyst had been established for a week. The micro-splint relieved typing discomfort and didn’t get in my way. After a few weeks of wearing it, and a regular splint when sleeping, the cyst abruptly flattened. I don’t know if it drained back into the joint, but it felt that way. I wore the micro-splint for a week or so and then forgot about it. I was careful to keep my wrist straight, though not terribly careful. Sometimes I did palmar pushups instead of straight wrist fist pushups.
Now I’ve got another one. I’ve recreated the splint, but perhaps because the cyst was new this time it flattened immediately. Maybe this time I’ll only need the velcro strap/coin for a week or two.
I doesn’t feel as though activity makes much difference — as long as I wear the splint and don’t extend the wrist (as in a palm-down pushup). So my CrossFit pushups are now fist down, and I’m putting my handstand pushups on hold for a few months (I’ll do wall-walk fist down, wrist straight instead — which should be more painful, hence better).
Caveat emptor. This isn’t science, it’s anecdote. If you try it, don’t blame me when your sarcoma metastasizes (not every lump is a benign cyst). 

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