Ganglion Cyst of the Wrist and Hand – OrthoInfo

Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in many locations, but most often develop on the back of the wrist.

These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment. However, if the cyst hurts, if it affects function, or if you are unhappy with how it looks, there are several treatment options available.

A ganglion arises out of a joint, like a balloon on a stalk. It grows out of the tissues surrounding a joint, such as ligaments, tendon sheaths, and joint linings. Inside the balloon is a thick, slippery fluid, similar to the fluid that lubricates your joints.

The most common location of a ganglion cyst is on the back of the wrist.

Ganglion cysts can develop in several of the joints in the hand and wrist, including:

• Both the top and underside of the wrist
• The end joint of a finger
• The base of a finger

They vary in size, and in many cases, grow larger with increased activity. With rest, the lump usually becomes smaller.

It is not known what triggers the formation of a ganglion.

• They are most common in younger people between the ages of 15 and 40
• Women are more likely to be affected than men.
• They are common among gymnasts, who repeatedly apply stress to the wrist.
• Ganglion cysts that develop at the end joint on the nail side of a finger — also known as mucous cysts — are typically associated with arthritis in the finger joint and are more common in women between the ages of 40 and 70.

A mucous cyst at the end of the index finger.

Most ganglions form a visible lump; however, smaller ganglions can remain hidden under the skin (occult ganglions). Although many ganglions produce no other symptoms besides the appearance of a mass, if a cyst puts pressure on the nerves that pass across the joint, it can cause pain, tingling, and muscle weakness.

If you have a large cyst, even if it is not painful, you may feel anxious or unhappy simply because of how it looks.

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Medical History and Physical Examination

During the initial appointment, your doctor will discuss your medical history and symptoms. They may ask you:

• How long you have had the ganglion
• Whether it changes in size
• Whether it is painful

Your doctor may apply pressure to the cyst to test for tenderness or discomfort. Because a ganglion is filled with fluid, it is translucent (almost transparent). Your doctor may shine a penlight up to the cyst to see whether light shines through. This can help confirm that the mass is truly a cyst and not a solid tumor.

Imaging Tests

X-rays. X-rays create clear pictures of dense structures, like bone. Although X-rays will not show a ganglion cyst, they can be used to rule out other conditions, such as arthritis of the hand, arthritis of the wrist, or a bone tumor.

Magnetic resonance imaging (MRI) scans or ultrasounds. MRI scans and ultrasounds can better show soft tissues, like a ganglion, than X-rays. Sometimes, an MRI or ultrasound is needed to find an occult ganglion that is not visible, or to distinguish the cyst from other tumors. However, further imaging is often not needed prior to treatment. 

Nonsurgical Treatment

Initial treatment of a ganglion cyst is nonsurgical.

Observation. If you have no pain or other symptoms, your doctor may recommend just waiting and watching to make sure that no unusual changes occur. This is typically safe because ganglions are not cancerous and may disappear on their own in time.

Immobilization. Activity often causes the ganglion to increase in size, which may increase pressure on surrounding nerves, causing pain. A wrist brace or splint may relieve symptoms and cause the ganglion to decrease in size. As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion.

Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it.  This procedure is called an aspiration.

The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid can be withdrawn.

Unfortunately, aspiration often fails to eliminate the ganglion because the root or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not addressed. Thus, in many cases, the ganglion cyst returns after an aspiration procedure.

Aspirations are most often used for ganglions located on the top of the wrist. Ganglions on the palm side of the wrist can be tricky to aspirate because they are near major vessels and nerves.

During an aspiration procedure, the fluid is drained from the ganglion cyst.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

 Surgical Treatment

Your doctor may recommend surgery if your symptoms are not relieved by nonsurgical methods, or if the ganglion returns after aspiration. The procedure to remove a ganglion cyst is called an excision.

Surgery involves removing the cyst as well as addressing the stalk from which the cyst arises. This may mean removing part of the involved joint capsule or tendon sheath to ensure removal of the root of the cyst. Even after excision, there is a small chance the ganglion will return.

Excision is usually an outpatient procedure, meaning patients go home the day of surgery after a period of observation in the recovery area. There may be some tenderness, discomfort, and swelling after surgery. You are usually able to resume normal activities 2 to 6 weeks after the procedure.

A ganglion cyst at the wrist is removed during a surgical procedure called excision.

Ganglion cysts rarely, if ever, cause permanent disability. Cysts that do not go away on their own and cause symptoms almost always respond to surgery. In the rare case that a ganglion comes back after surgery, a revision surgery can be performed to remove the cyst again. After removal, most patients experience relief of symptoms. 

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Cysts – ganglion cysts – Better Health Channel

Summary

Read the full fact sheet

• A ganglion cyst is a benign ball of fluid that grows on a tendon or joint.
• The backs of the hands and wrists are most commonly affected, but ganglion cysts can also grow on the feet, knees and ankles.
• The cause is unknown, but it is thought that small tears in the tendon membrane or joint capsule allow the contents to squeeze out.
• In many cases, ganglion cysts go away by themselves without the need for medical treatment.
• Treatment options include surgery or draining the cyst with a needle.

A tendon is a tough band of connective tissue that joins muscle to bone. Tendons and joints have a covering of membrane that produces a lubricating fluid to assist their function. A ganglion cyst is a benign (non-cancerous) ball of fluid that grows on the membrane or sheath that covers these tendons and joints. The backs of the hands and wrists are most commonly affected, but ganglion cysts can sometimes grow on the feet, knees and ankles. A ganglion cyst is the most common lump on the hand, and tends to target women between the ages of 20 and 40 years of age, for reasons unknown.

As tendons anchor muscle to bone, a ganglion cyst on a tendon may cause muscle weakness. Depending on the individual, there may be just one large lump or a collection of many smaller ones attached to a single ‘stalk’ deeper in the tissue. Around one third to one half of ganglion cysts disappear on their own without the need for medical treatment. However, it is best to consult your doctor to make sure the swelling is not a symptom of some other type of illness.

Symptoms of ganglion cysts

The symptoms of a ganglion cyst include:

• 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 any nearby joints.
• 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 (Bakers cyst), ankle, foot, palm and fingers.

Causes of ganglion cysts

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

• The body responds to injury, trauma or overuse by forming an internal ‘blister’.
• Small tears in the tendon membrane or joint capsule allow the contents to squeeze out.

Ganglion cysts can disappear

Around 30 to 50 per cent of ganglion cysts disappear by themselves without the need for medical treatment. However, it is always best to consult your doctor to make sure the lump isn’t a symptom of some other disease. If your ganglion cyst is painful, or if it interferes with your mobility or causes sensations of numbness or pins and needles, see your doctor.

Diagnosis of ganglion cysts

Ganglion cysts are diagnosed using a number of tests including:

• Medical history
• Physical examination
• Ultrasound
• X-rays
• Needle aspiration (a fine needle is used to draw off fluid, which is then examined in a laboratory).

Treatment for ganglion cysts

Ganglion cysts used to be treated by slamming them with a heavy book such as a Bible – which explains the term ‘Bible therapy’. This isn’t a good idea, as you could cause further injury. Medical treatment options include:

• 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 cysts involves drawing off the fluid with a fine needle. In many cases (around 75 per cent), this treatment empties the cyst and no further action is needed.
• Surgery – the cyst or cysts are surgically removed, usually by a specialist such as an orthopaedic surgeon. Ganglion cysts of the feet will usually require surgery.

Joint mobility after treatment

Whether your ganglion cyst is aspirated or surgically removed, you will be fitted with a splint for around one week or so. Depending on the location of the excised ganglion cyst, full recovery can be anywhere from two to eight weeks. Be guided by your doctor or health care professional, but generally it is best to get the joint moving again as soon as possible. Using splints for extended periods of time can actually hamper joint mobility. Your doctor will give you specific exercises to perform.

Ganglion cysts may return

Ganglion cysts may grow back after treatment. This is less likely if your cysts 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 cysts is unknown, prevention is impossible. If you suspect your ganglion cyst is recurring, see your doctor for further treatment. A ganglion cyst that is aspirated three times has a better than 80 per cent chance of being cured.

Where to get help

• Your GP (doctor)
• Orthopaedic surgeon

• Ganglion cystExternal Link, Indiana Hand Centre, MANUS, USA.

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Blog | Ganglion cysts (ganglion cysts)

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• Ganglion cysts (ganglion cysts)

A ganglion cyst is a fluid-filled lump under the surface of the skin that appears near joints and tendons. They usually do not cause any symptoms and often go away on their own. Treatment ranges from observation to outpatient surgery called a ganglionectomy.

What is a ganglion cyst

A ganglion cyst (plural ganglion) is a small, fluid-filled tumor just under the skin. Ganglia usually form close to the joint. Most ganglion cysts are on the wrist, finger, or foot.

How common are ganglion cysts

Many people develop ganglion cysts. Ganglia are one of the most common benign (noncancerous) formations that develop in the soft tissues of the body.

What causes ganglion cysts

Nobody knows exactly what causes ganglion cysts to grow. Some theories indicate that a cyst may develop after something damages the joint, causing tissue to leak or bulge.

Currently, most researchers agree that ganglion cysts develop from mesenchymal cells in the synovial-capsular junction as a result of continuous microtrauma. Repetitive damage to the supporting capsular and ligamentous structures appears to stimulate fibroblasts to produce hyaluronic acid, which accumulates to form the mucinous “jelly-like” material commonly found in ganglion cysts.

Who is prone to ganglion cysts

Based on what the medical community knows about ganglion cysts, anyone can get them. Certain factors can increase the chances of having one of these cysts. These factors include:

• Sex. Women develop ganglia three times more often than men.
• Age. Most people who develop a ganglion cyst develop it in early to middle age, between 20 and 50 years of age.
• Previous trauma. Some clinicians believe that trauma to the joint (eg, tendinitis due to overuse of the wrist) may trigger the development of a ganglion cyst in the future. Research has yet to confirm this theory.
• Arthritis. The presence of arthritis in the hands increases the likelihood of developing a ganglion cyst. People with arthritis often develop a ganglion cyst at their fingertips (in the joint closest to the nail). But having a ganglion cyst on your finger doesn’t mean you have (or will have) arthritis.

What are the symptoms of ganglion cysts

A bump under the skin is the main sign of a ganglion cyst. This bump can vary in size and shape. It may increase over time or as you use the area (the joint) more. The cyst may not bother you at all. If you have symptoms, you may notice some muscle pain or tingling at the site of the cyst. This is usually a mass effect, which means that the mass causes pressure and can cause inflammation.

Where ganglion cysts appear

Ganglion cysts usually appear in certain joints. Using a joint near the cyst can increase the swelling and any discomfort you feel.

Ganglion cysts usually develop on parts of the body such as:

• Wrist, front or back.
• Finger, near any joint of the finger (next to the palm or just below the nail).
• Foot, closer to the ankle or toes.

What a ganglion cyst looks like

A ganglion cyst usually looks like a swelling on the wrist, finger or foot. This bump may look symmetrical (round) or deformed (more like an oval).

The ganglion cyst is located just below the surface of the skin. It may look like a bubble is blown out of the joint. Ganglia sometimes have a translucent effect (can be seen through the lump at certain angles).

Ganglion cysts, hard or soft

People experience ganglion cysts differently. Ganglia are usually (but not always) hard to the touch. Some people report that fluid-filled cysts are soft. The bump will likely move easily under the skin.

How a Ganglion Cyst is Diagnosed

Ganglion cysts are usually diagnosed by healthcare professionals by doing a physical examination. The appearance and location of the lump (for example, on the wrist or fingers) are clear signs of ganglia. Your doctor may press on the bulge to see if it’s bothering you. Or he can shine a light on the bump to see if it is translucent (partially transparent).

In some cases, the doctor may take a sample from the lump (called a biopsy) for further analysis. Ganglia usually contain a jelly-like fluid rather than hard tissue. In rare cases, a doctor may recommend an x-ray to learn more about the mass if it is causing symptoms.

Your doctor may also use ultrasound to tell the difference between a solid mass and a cyst. There is also a difference between a ganglion cyst and a synovial cell. The difference lies in the composition of the cyst mucosa.

Can there be problems with an occult ganglion cyst

Some ganglion cysts are so small that they don’t cause obvious physical swelling, but still cause pain. They are known as the occult ganglia. Your healthcare provider may order magnetic resonance imaging (MRI) or ultrasound to look for them.

Do all ganglion cysts need treatment

If a ganglion cyst does not bother you, it may not need treatment. Sometimes a ganglion cyst goes away on its own.

Your doctor may recommend treatment if you have a ganglion cyst:

• Pain, which can happen when the cyst presses on a nerve or joint tissue.
• Makes certain movements or tasks difficult, such as walking or holding a pencil.
• Makes you feel ashamed of your appearance.

How ganglion cysts are treated

Treatment for ganglion cysts includes:

• Anti-inflammatory drugs. They will help minimize swelling and relieve mild discomfort.
• Splints or braces. Provides support and inhibits movement of the affected area, reducing swelling and pain.
• Aspiration is a procedure in which a doctor uses a needle to remove fluid from a cyst. Doctors usually do aspiration in their office. You may feel better right away. Because this treatment only removes the fluid and not the entire cyst, your symptoms may return.

When a ganglion cyst needs surgery

Your doctor may consider surgery if other treatments fail or your cyst comes back. Surgeons treat ganglia by removing the entire cyst. The cyst often includes a stalk-like structure (root) attached to the cyst.

Your surgeon may use open (traditional) techniques or arthroscopy (small incisions). In some cases, surgeons may remove tissue from a nearby joint to completely fix the problem.

Surgery to remove a ganglion cyst is called a ganglionectomy. This is usually an outpatient procedure. This means that you will be able to return home on the day of the operation. Full recovery takes two to six weeks. Orthopedic surgeons are specially trained to perform complex operations on the joints and other soft tissues of the body.

Surgery can effectively eliminate symptoms. Surgical removal of a ganglion cyst significantly reduces the risk of cyst recurrence. However, the ganglia return after surgery in about 5-15% of cases.

Is it possible to prevent ganglion cysts

You cannot prevent a ganglion cyst. Medical experts do not know what causes them to develop.

Are ganglion cysts dangerous?

Ganglion cysts are not dangerous. These are benign growths, which means that they will not spread to other areas. Ganglion cysts are not cancer.

What is the prognosis (outlook) for people with ganglion cysts

Although some ganglion cysts can be painful, they do not pose a serious threat to your health.

What questions should I ask my doctor

If you have a ganglion cyst, you can ask your doctor the following:

• Do I need treatment right now?
• What treatment options do you recommend I try first and why?
• What are the chances that the cyst will return after treatment?
• When would you consider surgical treatment of ganglion cysts?
• What are the risks and benefits of ganglionectomy surgery?

If you have a ganglion cyst, you may not need treatment right away. If it does not bother you, your doctor may monitor you for some time to see if there are any changes to the growth. Ganglion cysts are benign, which means that these growths are not cancer. They do not pose a long-term threat to your health. Many ganglion cysts disappear on their own. If a ganglion cyst is affecting your quality of life in any way, ask your doctor about treatment options. Splints, over-the-counter pain relievers, or surgery may help.