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— C. Noel Henley, MD (@handarmdoc) February 9, 2015
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Friday, Miley Cyrus posted pictures of her wrist surgery on Instagram. Here’s the most likely story behind the graphic picture that’s all over the internet.
Miley most likely had a ganglion cyst. It’s the most common tumor of the hand and wrist – and it’s completely benign. In this picture of Miley dancing you can see a subtle lump on her left wrist. Apparently this was taken recently, just before the surgery. This is the exact spot where the cyst is typically located. A cyst is a fluid filled tumor (a tumor just means “a swelling”). A ganglion cyst comes from a joint and is filled with a clear jelly. Here’s a video of a ganglion cyst being removed in surgery.
Most patients do not have much pain with these. However, they can cause some discomfort, especially with hyperextension of the wrist. In rare cases they can push on a nerve and cause numbness or tingling in the hand.
Ganglion cysts occur in people of all ages. Little kids all the way up to elderly people. In young people like Miley, they’re almost always caused by small microtears in the joint lining that let fluid escape from inside the joint. The fluid collects outside the joint and forms a cyst.
Cysts can sometimes be ruptured with a needle in the doctor’s office. When the cyst is on the palm side of the wrist (like Miley’s), it is right next to the radial artery, the major source of blood flow into the hand. So it can be risky to put a needle into these cysts – the artery may be damaged. Sometimes it’s safer to just leave the cyst alone or remove it in surgery. Risks of taking out Miley’s cyst include: small risk of infection, damage to a small nerve next to the cyst, and damage to the radial artery. The cyst could also come back – there’s about a 5% chance of that.
In this picture we see Miley’s left hand, palm up on a blue background. That’s a surgical towel covering up the table where the surgeon works. The gloved hands are either the assistant’s hands or the surgeon’s hands. The circulating nurse is probably taking the picture by holding the camera above Miley’s wrist while the surgeon holds the retractors. The retractor on the left side is closest to the radial artery – it’s a blunt retractor, probably called a Senn rake. It has one blunt end and a sharp, rake-like end. You can see what the other end looks like on the right side of the picture. On the right side of the incision you can see something white – that’s a large tendon called the Flexor Carpi Radialis tendon. These cysts poke up right between the radial artery and the FCR tendon. If you want to Google other pictures of the type of cyst Miley had – just type in “volar ganglion cyst” into Google Images. The ink around the incision is used by the surgeon to mark where the incision should be. Sometimes the surgeon uses a smaller incision than where he marks. You can see the incision doesn’t go quite as far up toward the fingers as he’s marked on Miley’s wrist. You can also see the marking pen on the towel at the bottom of the picture. The smiley face is drawn on the cyst itself – I can’t tell if this was done later after the photo was taken or drawn by the surgeon on the actual cyst.
The surgeon uses a tourniquet to prevent blood from flowing into the surgical incision so he can see all the anatomy. This lowers the chance he’ll cut something he shouldn’t.
Probably. These surgeries can easily be done with the patient awake or just sedated, with their arm numbed up. She may be awake enough to look at the cyst but then probably laid back down to let the surgeon keep working. In this picture, Miley has an ID bracelet and what looks like an IV in her right arm, and nothing on the arm with the cyst on it. That means she was at least sedated for the surgery, if not asleep completely.
Post more questions about this type of surgery in the comments below!
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