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Mathias Masem, M.D.
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Shoulder | Elbow | Wrist | Hand

Ganglion Cyst

What are ganglion cysts?

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons. The most common locations are the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger. The ganglion cyst often resembles a water balloon on a stalk and is filled with clear fluid or gel. The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.

Ganglion Cysts
How are ganglion cysts diagnosed?

The diagnosis is usually based on the location of the lump and its clinical appearance. They are usually oval or round and may be soft or very firm. Cysts at the base of the finger on the palm side are typically a very firm, pea-sized nodule that is tender to applied pressure, such as when gripping. Light will often pass through these lumps (trans-illumination) and this can assist in the diagnosis. Your physician may request x-rays in order to investigate problems in adjacent joints; cysts at the end joint of the finger frequently have an arthritic bone spur associated with them.

What are the treatment options for ganglion cysts?

Treatment can often be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless. If the cyst becomes painful, limits activity, or is cosmetically unacceptable, other treatment options are available. The use of splints and anti-inflammatory medication can be prescribed in order to decrease pain associated with activities.

An aspiration can be performed to remove the fluid from the cyst and decompress it. This requires placing a needle into the cyst, which can be performed in most office settings. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available. Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques may yield good results. Surgical treatment is generally successful although cysts may recur. Your surgeon will discuss the best treatment options for you.

How successful is treatment?

It depends on several things.

  • Tendon sheath cysts are more likely to be cured with a cortisone shot than cysts coming from joints.
  • Cysts coming from joints are less likely to come back after surgery if the joint itself is "cleaned out", but cleaning the joint out increases the chance that the joint will be somewhat stiff after surgery.
  • Cysts on the front of the wrist (volar wrist ganglions) are more likely to come back after surgery than cysts on the back of the wrist (dorsal wrist ganglions).
What happens if you have no treatment?

This depends on what kinds of problems you're having, but it is a good idea to have your cyst checked out by a doctor and possibly have x-rays to make sure that you are not ignoring a potential health problem. For example,

  • Painful cysts may be painful because of underlying problems other than a simple cyst. Although uncommon, pain associated with a ganglion may be due to underlying arthritis, bone tumor, ligament injury or fracture.
  • Cysts can extend into the underlying bones and cause other types of problems.
  • Cysts on the back of the end joint of the finger (mucus cysts) may gradually thin and weaken the overlying skin, allowing liquid to drain out but also allowing bacteria to enter the joint, sometimes causing a serious infection.
  • Between one-third and two-thirds of wrist ganglions eventually go away with no treatment.