Cysts, Lumps, and Bumps!

Encountering unfamiliar cysts, lumps and bumps on our hands, arms or elbows can be stressful. Are they malignant? Should I be worried? Will they go away on their own?

The good news, according to Dr. Donnelly is, most cysts, lumps and bumps are easy to spot, common and generally harmless.

“Fortunately, malignant tumors and masses in the hands are very uncommon – other than skin cancers,” Donnelly says. “Sometimes you’ll have one and they’re rapidly growing and painful. So, those are the buzzwords I use: rapidly growing, overlying skin changes, could be painful – that’s where you want to get those checked out.”

In today’s blog post Dr. Donnelly discusses the characteristics and causes of a wide range of cysts, lumps and bumps you may find on your hands, wrists, and elbows, as well as various treatment options.

Ganglion and Retinacular Cysts - What’s the Difference?

For the most part, the difference between ganglion and retinacular cysts is where they are located. The ganglion cyst typically arises from a joint, whereas the retinacular cyst sits on a sheath, most often on the tendon. They’re usually small. A ganglion cyst, particularly the ones on the wrist, can get to the size of a grape. Usually, they’re more the size of chickpea. Retinacular cysts are usually about the size of a BB, or a very small green pea. They’re both fluid filled, with a gelatinous type of tissue.

What causes ganglion and retinacular cysts?

Sometimes, it can be a weak area. In the case of ganglion, you might get a weak area in the covering of the joint, and a little fluid escapes in a balloon. For the retinacular, it’s more often an inflammatory process with the tendon. They just develop a little extra fluid in the area, and that attaches itself to an enclosed capsule – again, like a balloon. It attaches to the sheath or the tunnel that tendons run through.

Are ganglion and retinacular cysts treated differently?

Ganglion cysts are most often on the back side of the wrist, and sometimes they’re not that noticeable. So, if they’re not noticeable and they’re not bothering the patient, we leave them alone. I have ganglion cyst, and it doesn’t bother me. I show it to all of the patients with cysts.

"I have a ganglion cyst, and it doesn’t bother me. I show it to all of my patients with cysts."

Ganglion cysts can be painful, particularly during an extension of the wrist – meaning push-up activities, or yoga. In those instances, you can choose to aspirate it, or suck out the fluid, and put a little steroid in there, or you would do surgery to excise it.

The retinacular cysts, on the other hand, are more symptomatic – because they are right in the area where we are trying to grip something. They’re point tender. Oftentimes, they’re at risk of rupture, so I’ll inject them with a little numbing medicine then we’ll pop it, like popping a balloon.

What are Soft Tissue Masses?

Soft tissue masses are cell growths that can develop nearly anywhere on the body. As the name implies, soft tissues like blood vessels, cartilage, fat, ligaments, muscles, nerves, tendons, and other tissues can develop masses. When we talk about cysts, lumps, and bumps, soft tissues masses are typically the lumps and bumps.

What are giant-cell tumors?

The giant-cell tumor of the tendon sheath is probably the most common soft tissue mass we see. It’s a benign accumulation of what we call “giant cells,” a particular type of cell that forms into a tumor. It’s not related to trauma, or anything like that. Like a lot of cysts, lumps, and bumps, they just happen; there’s no definitive cause for it.

Giant cell tumors are most often found along the palm side of the fingers. they are usually slow growing. They are not usually painful, and oftentimes arise from the joint. The treatment for that is a surgical excision. But they have a chance for recurrence.

What are lipomas?

Lipomas are essentially just fatty tumors. They’re not very common in the hand; most often, people have them on their arms or legs – and most of the time in the subcutaneous tissue. So, underneath the skin but outside of the muscles. It feels like a little rubbery ball, or rubbery mass. Again, like many cysts, lumps, and bumps, you can observe them and just watch them, but the definitive treatment for that would be a surgical excision.

Do skin cancers cause cysts, lumps, and bumps?

Skin cancers may also cause lumps and bumps. Most of the time, when I’m treating skin cancers, I’ll do a resection - surgically removing part or all of a tissue or structure. The dermatologist will send them to us for that. A lot of skin cancers, if caught early enough, will be treated by the dermatologist or a dermatological surgeon. Sometimes, we will do the reconstruction after that.

Other types of cysts, lumps, and bumps

What are epidermal inclusion cysts?

Epidermal inclusion cysts are fairly common to the hand. An epidermal inclusion cyst forms from irritation of the skin or hair follicles. When popped, the content comes out as a yellow, waxy, almost cheesy material.

What is a glomus tumor?

A glomus tumor is an uncommon tumor that’s usually found on the fingertip, underneath the nail. It’s exquisitely painful, and it’s very sensitive to cold temperatures. Sometimes you can see it as a darkish hue, a discoloration under the nail. Usually, you don’t see any other signs. It’s something we diagnose clinically, then confirm with an MRI. Fortunately, a glomus tumor responds very well to surgical excision.

What is a Dupuytren nodule?

When discussing cysts, lumps, and bumps, we should mention the Dupuytren nodule, a thickening of the palm tissue. It develops into a lump that’s almost always non-painful, except when someone is trying to grip or hold on to something. They’re typically right in the part of the hand where you’d hold on to a steering wheel, bicycle, weights or things like that. Sometimes, it can be post-traumatic, but it’s part of the Dupuytren spectrum, where you have an abnormal growth in the palm tissue. That’s genetic in nature.

What is a carpal boss?

A bony mass that you sometimes see on the back of the hand is called a carpal boss. It’s just an overgrowth of the bones right at the base of the hand where it meets up with your wrist. It’s usually firm, and sometimes can be sensitive. It’s sometimes referred to as a boxer’s bump, because it’s more common in people who punch or hit because of the load put on that particular part of the bone. Usually, we leave those alone. If they are very painful, then you go in and excise that little overgrowth of the bone.

What is olecranon bursitis?

When examining cysts, lumps, and bumps on the elbow, we might see olecranon bursitis. That’s a variable-sized bump that we get on the backside of the elbow, right over the tip of the elbow. It can be associated with a mild trauma, or repetitive leaning on the elbow. I see it commonly with truck drivers, and mechanics who are working underneath the car and have to use their elbows to shimmy themselves around.

More often than not, it’s just a fluid-filled sac that develops from the irritation in that area. With the right conservative measures, you can find relief with a compression wrap or an elbow pad. The biggest thing is to avoid that repetitive trauma. Sometimes, we’ll drain the fluid with a needle. Infrequently, it gets infected and becomes big, red and swollen. Sometimes, we can just drain it and treat it with antibiotics. Other times, we need to do a surgical excision.

Have a Curious Cyst, Lump, or Bump?

Most skin lumps and bumps in the upper extremity are harmless, and won’t change into cancer. However, if you have a lump, bump or cyst that’s become painful, begun to grow or change appearance rapidly or caused changes in the skin, call Dr. Brandon P. Donnelly today to schedule an evaluation.

About Dr. Brandon P. Donnelly, MD

Dr. Brandon P. Donnelly is a board certified orthopedic surgeon with Pontchartrain Orthopedics & Sports Medicine. Dr. Donnelly completed his hand and microsurgery fellowship at the prestigious Philadelphia Hand to Shoulder Center. Dr. Donnelly treats all ages of patients in the greater New Orleans area for hand, wrist, and elbow conditions.

This site is not intended to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this website and links to other websites, Brandon P. Donnelly, MD provides general information for educational purposes only. The content provided in this website and links, is not a substitute for medical care or treatment. You should not use this information in place of a consultation or the advice of your healthcare provider. Brandon P. Donnelly, MD is not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site.