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Facts about ganglion cyst (Bible bump)



SHE is in her 50s, and has been having a tingling sensation which was accompanied by a rather large lump on the top of her wrist. As the pain increases, she decided it was time to see a doctor and the following conversations ensued.

Patient:-(Knock) at the door, good morning doctor.

Doctor:-Good morning ma, come right in ma and have a seat.

 Patient:-Thanks doctor,

Doctor:-How can I help you.

  Patient:-look at this lump….(she showed her wrist to the doctor).

  Doctor:-Ganglion. It’s a common problem. It’s by far the most common tumour of the hand or wrist.

  A ganglion cyst is a fluid filled bump associated with a joint or tendon sheath. They most often occur at the back of the wrist followed by the front of the wrist. A ganglion is a growth under the skin, usually appearing on the wrist or ankle. The cyst is made up of the tissue that covers the nearby tendons. Some ganglion cysts become tight and hard, and may be painful. Others stay soft, causing no pain or discomfort.

 Ganglion cysts account for 60% to 70% of soft tissue masses in the hand and wrist, commonly found in woman. 70% occur in people from 20-40 years of age.


*A noticeable swelling or lump.

*The lump is able to change its size, including going away completely only to return.

*The lump is usually soft and immobile.

*In some cases, the lump is painful and aching, particularly those at the base of fingers.

*The ache and pain is made worse by moving away nearby joints.

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*The affected tendon may cause a sensation of muscular weakness.*The back of the hands and wrists are most commonly affected.

 *Other sites include the back of the knee.(Baker’s cyst),ankle, foot, palm, fingers.

Causes No one knows what causes a ganglion cyst to form. Some of the theories include:-

*The body response to injury, trauma, or over use by forming an interval “blisters”.

*Small tears in the tendon membrane or joint capsule allow the contents to squeeze out.


  Around 30-50% of ganglion cysts disappear by themselves without the need for medical treatment.

 Diagnosis of ganglion cyst

 *Medical history

*Physical examination.  



*Needle aspiration ( Fine needle is used).


  Usually, no treatment is needed, especially if the ganglion cyst causes no pain. However, your doctor may drain the cyst with a large needle.

  Surgery can be done to remove the cyst if it is bothersome and won’t go away. Typically, ganglion cysts disappear on their own.

  In earlier days, people would treat this lump by smacking the cyst/lump with a heavy book, often the Bible(this is called the Bible therapy)-hence the name ‘Bible Bump’.

 But these days, it can be by:

 Close monitoring:-If the ganglion cyst isn’t causing pain or interfering with movement, some doctors prefer to wait and see. The cyst may simply disappear on its own.

  Needle aspiration:- One of the tests to diagnose ganglion cyst involves drawing off the fluid with a fine needle. In many cases (around 70%), this treatment empties the cyst and no further action is needed.

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  Surgery: – The cysts are surgically removed, usually by a specialist such as an Orthopaedic Surgeon. Ganglion cysts of the feet will usually require surgery.

  Finally, ganglion cyst may grow back after treatment. This is less likely if the cyst were surgically removed rather than aspirated with a needle. Some estimates suggest that around half of patients who undergo needle aspiration can expect a recurrence. Since the cause of ganglion cyst is unknown, prevention is impossible. If one suspect his or her ganglion cyst is recurring, see the doctor for further treatment.

  A ganglion cyst that is aspirated three times has a better than 80% chance of being cured.



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