Ganglion Cyst

What is a Ganglion Cyst?

A ganglion cyst is a noncancerous lump near joints or tendons in the hand or wrist, commonly found on the back of the wrist or near finger joints. It’s filled with clear, gel-like fluid and may vary in size, sometimes disappearing on its own. The cyst is connected to a joint or tendon sheath and resembles a water balloon on a straw.

Causes

Ganglion cysts can occur in people of any age, but are more common in:

• Those with joint or tendon irritation

• People with arthritis

• Individuals with a history of wrist or finger injury

• Those who use their hands repetitively

Despite these associations, a clear single cause has not been identified.

Signs & Symptoms

• Cysts are usually round or oval and may be soft or very firm

• Palm-side cysts at the base of the fingers are often small and firm, about the size of a pea, and tender when gripping

• Mucous cysts (just below the fingernail) are associated with arthritis and may cause a groove or dent in the nail

• The skin over the cyst can become thin or stretched, especially with mucous cysts, and may break open, leaking fluid

• May cause discomfort but are often painless

• Can be mistaken for warts or infections

Diagnosing a Ganglion Cyst

Diagnosis is typically based on:

• Location and appearance of the lump

• Transillumination (light passing through the cyst)

• X-rays to check for joint issues

• Ultrasound or MRI, if needed, to confirm the cyst or assess deeper structures

Your doctor will also take a full medical history and perform a physical exam.

Treatment Options

Non-Surgical Treatments

Many ganglion cysts do not require treatment, especially if they’re painless or don’t affect function. They may even disappear on their own. Treatment options include:

• Observation: Monitor over time without active intervention

• Splinting & Anti-inflammatories: Can reduce discomfort with activity

• Aspiration:

  • Needle is inserted to remove fluid

  • May be done with or without ultrasound

  • Sometimes fluid is too thick to remove completely

  • Recurrence is common because the cyst wall and stalk remain connected to the joint

Aspiration may be tried multiple times, but it is not always a permanent solution.

Surgical Treatment

Surgery is considered when:

• The cyst is painful, recurs, or interferes with hand use

• Non-surgical treatments have failed

Surgical approach involves:

• Removal of the cyst, its stalk, and possibly surrounding joint capsule or tendon sheath

• Options include open surgery or arthroscopic techniques, especially for wrist cysts

Surgery is usually effective, but there is still a risk of recurrence. If a cyst comes back but doesn’t hurt, it can often be left alone. If it becomes painful again, repeat surgery may be necessary.

Your hand surgeon will discuss the best course of action based on your specific condition and symptoms.