After competing in a regional gymnastics meet, Jessica showed her family a bump on the back of her wrist that had begun to bother her. Immediately her grandfather offered to treat her “bible bump”. He then explained that in the past a common treatment for a ganglion cyst required the patient to put her hand on the kitchen table and allow a trusted family member to smash it with the large family Bible. This “treatment” ruptured the wall of the cyst, allowing its contents to drain into the surrounding soft tissues. He told her that it must have worked because very few people complained about a recurrence.

What is a ganglion cyst?

“Bible bumps” in the medical world are known as ganglion cysts. They are filled with the fluid that lubricates joints and tendons (synovial fluid). The most common location is the wrist but they can be associated with any joint or tendon. They resemble a water balloon filled with clear gel.

Families should be reassured that ganglion cysts are not destructive to adjacent tissues nor are they malignancies.

Are ganglion cysts common?

They are most often found around the wrist, arising from the joint between two of the carpal bones (scaphoid and lunate) accounting for 80% of all ganglion cysts.

What causes ganglion cysts?

The cause of these cysts is unknown although they may form as a result of trauma or joint or tendon irritation. They can be found in all age groups. In some instances they seem to run in families.

What are the symptoms of a ganglion cyst?

These bumps are rarely painful. At extreme range of motion of a joint they may be uncomfortable. Cysts located on the palm side of the fingers and hand are very firm in nature and may be painful with gripping activities.

Cysts can fluctuate in size, especially with changing patterns of activity.

How are ganglion cysts diagnosed?

Diagnosis is based on the location and appearance of the bump. Occasionally x-rays are helpful to rule out adjacent bone deformity. Because the fluid within the cyst is clear, light can pass through these bumps (trans-illumination).

How are ganglion cysts treated?

Most pediatricians and hand surgeons recommend simple observation for the vast majority of ganglion cysts. Cysts that become excessively large or uncomfortable because of their size and location may require treatment. Surgical treatments remain the primary option for painful or excessively large cysts. Ganglion cysts have been found to recur following surgery in approximately 5% of pediatric patients treated at Rocky Mountain Hospital for Children.

Alternatively, a needle may be used to drain the fluid from the cyst (aspiration). If the fluid has thickened, this treatment is not always effective. Because multiple aspirations are frequently required, this treatment is poorly tolerated by children.

What is the long-term outlook for my child?

Since most ganglion cysts resolve with time, the long term outlook is one of full pain-free activity for your child. Even after surgical removal of the cyst your child resumes normal activities within 2 – 3 weeks.

Rather than resorting to an old fashioned treatment, Jessica and her family visited with her pediatrician who reassured them that observation was a great course of action but that if the pain were to worsen she could be referred to the pediatric hand specialist.