Wrist Pain: Causes, Treatment Options, and Surgery Risks - Orthopedics

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Wrist pain


Hello Doctor: About fourteen years ago, I sprained my wrist while doing pull-ups and went to the hospital.
The doctor said it was a tendon tumor.
Recently, for the past two weeks, I have been experiencing pain when bending my wrist up and down, and pressing on the tendon tumor also causes pain.
I would like to ask the doctor why it suddenly hurts now? Is surgery necessary? Thank you! P.S.
The wrist issue has been bothering me for several years.
If I decide to have it removed, will there be any side effects?

Xiang Ying, 20~29 year old female. Ask Date: 2005/12/15

Dr. Li Wenlin reply Orthopedics


Hello: In response to your question, a tendon tumor may refer to what is commonly known as a ganglion cyst.
This common benign tumor of the hand typically does not present symptoms.
Symptoms usually arise when the cyst is located near tendons, ligaments, nerves, or blood vessels, and as it gradually enlarges, it can cause pressure-related symptoms such as aching, pain, numbness, or a tingling sensation.

Surgery is not always necessary for ganglion cysts, but there are certain situations where it may be required:
1.
If the cyst grows rapidly and is associated with symptoms such as aching, pain, or numbness.

2.
If the appearance of the cyst is bothersome.

3.
If it affects function, such as when located at a joint or on the palmar side, leading to restricted movement or difficulty in making a fist.
Surgery, except in very rare cases, can typically be performed under local anesthesia, which most people can tolerate.
The procedure is generally safe, with a low risk of damaging nerves, blood vessels, or other important structures.
However, it is worth noting that even with skilled surgeons, there is about a 10% recurrence rate.
Another treatment option involves aspiration using a large-bore needle.
The advantage of this method is that it can be performed in an outpatient setting, and the aspirated material is a clear, viscous fluid that can confirm the diagnosis of a ganglion cyst.
However, the recurrence rate is quite high.
In your case, for the painful symptoms, you might consider conservative treatment options such as rest, pain relievers, and splinting.
If these measures are effective, surgery may not be necessary for the ganglion cyst.
Wishing you a speedy recovery!

Reply Date: 2005/12/15

More Info


Wrist pain can be a complex issue, especially when it has persisted for many years. Based on your description, it seems that you have a history of a tendon cyst (often referred to as a ganglion cyst) that developed after an injury from performing pull-ups. This type of cyst can sometimes cause discomfort or pain, particularly if it is pressing against nearby structures such as tendons or nerves.


Causes of Wrist Pain
1. Tendon Cysts (Ganglion Cysts): These are fluid-filled sacs that can develop near joints or tendons, often in the wrist. They can cause pain, especially if they are large or located in a way that they compress surrounding tissues.

2. Tendonitis: Inflammation of the tendons in the wrist can occur due to overuse or injury, leading to pain during movement.

3. Arthritis: Degenerative changes in the wrist joint can lead to pain and stiffness, particularly in older adults or those with a history of joint injuries.

4. Nerve Compression: Conditions such as carpal tunnel syndrome can cause pain, tingling, or weakness in the wrist and hand due to pressure on the median nerve.

5. Previous Injuries: Past injuries, such as sprains or fractures, can lead to chronic pain if not properly rehabilitated.


Treatment Options
1. Conservative Management: This often includes rest, ice, compression, and elevation (RICE). Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation.

2. Physical Therapy: A physical therapist can provide exercises to strengthen the wrist and improve flexibility, which may alleviate pain.

3. Corticosteroid Injections: If inflammation is significant, a doctor may recommend corticosteroid injections to reduce swelling and pain.

4. Surgery: If conservative treatments fail and the cyst or underlying issue is causing significant pain or functional impairment, surgical intervention may be necessary. This could involve removing the cyst or repairing any damaged tendons.


Surgical Risks
While surgery can provide relief, it is essential to consider the potential risks, which may include:
- Infection: Any surgical procedure carries a risk of infection.

- Nerve Damage: There is a possibility of damaging nearby nerves during surgery, which could lead to numbness or weakness.

- Stiffness: Post-operative stiffness can occur, requiring rehabilitation to regain full range of motion.

- Recurrence: There is a chance that the cyst could return even after surgical removal.


Conclusion
Given that your wrist pain has suddenly intensified, it is crucial to consult with a healthcare professional who can perform a thorough evaluation. They may recommend imaging studies, such as an MRI or ultrasound, to assess the cyst and surrounding structures. Based on the findings, they can provide tailored advice on whether surgery is necessary or if other conservative treatments might be effective.

If you are considering surgery, discussing the potential benefits and risks with your surgeon will help you make an informed decision. It is also essential to understand that while surgery can alleviate pain, it may not guarantee a complete resolution of symptoms, and some patients may experience residual discomfort or complications.

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