Ganglion cysts are the most common lumps found in the hand and wrist. They are benign lesions which usually arise from an adjacent joint capsule or tendon sheath.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including carpal tunnel syndrome, trigger finger and thumb, thumb arthritis and Dupuytren’s disease.
What is a ganglion cyst?
A ganglion is best thought of as a sac, or cyst, arising from an adjacent joint capsule or tendon sheath. The cyst is filled with a thick jelly-like substance.
Ganglion cysts are benign and are not cancerous. They can arise from several areas in the hand and wrist, but the most common sites are the back of the wrist, the palm side of the wrist, the end finger joint and the base of the finger in the palm.
Where do ganglion cysts occur?
Ganglion cyst on the back of the wrist
The back of the wrist is one of the most common places for a ganglion cyst to develop. These cysts may appear as a visible lump and may be uncomfortable with wrist movement or pressure.
Figure 1: Typical appearance of a ganglion on the dorsal wrist.
A large ganglion on the back of the wrist.
Ganglion cyst on the palm side of the wrist
Ganglion cysts can also occur at the base of the thumb on the palmar side of the wrist.
Mucoid cyst at the end finger joint
A ganglion cyst at the end finger joint is called a mucoid cyst. These cysts are often associated with underlying osteoarthritis in the end joint of the finger.
A mucoid cyst can cause grooving or deformity of the fingernail. Sometimes the cyst may spontaneously discharge clear jelly-like fluid from the nail fold. If this happens, a secondary infection may develop.
Figure 4: A large mucoid cyst at the end of the finger causing grooving of the fingernail.
Flexor sheath or pearl ganglion
A ganglion cyst can also occur at the base of the finger in the palm. This is called a flexor sheath ganglion or “pearl” ganglion.
Patients with flexor sheath ganglions may experience discomfort in the palm when objects are gripped in the hand.
What causes ganglion cysts?
Despite being common, the exact cause of ganglion cysts remains uncertain.
The most popular theory is that they form as part of a degenerative process affecting the tissue which produces synovial fluid. Synovial fluid normally lubricates a joint or tendon sheath. A ganglion develops when this fluid accumulates outside the joint or tendon sheath in a sac or cyst.
In mucoid cysts, the ganglion usually develops as a consequence of underlying joint osteoarthritis and there may be pain on joint movement.
Symptoms and signs of ganglion cysts
Ganglion cysts usually present as a lump in one of the typical areas described above. The lump may be cosmetically unsightly and can fluctuate in size, becoming bigger and smaller.
These lumps often do not cause symptoms, but they can be uncomfortable, painful or locally tender.
Symptoms may include:
- A visible or palpable lump in the hand, wrist or finger
- A lump which changes in size
- Local tenderness or discomfort
- Pain with wrist or finger movement
- Discomfort when gripping objects
- Nail grooving or nail deformity in mucoid cysts
- Clear jelly-like discharge from a mucoid cyst, occasionally followed by infection
How is a ganglion cyst diagnosed?
Your doctor will usually diagnose a ganglion without additional investigations. The lumps are typically hard to touch and often feel like a bony lump.
Ganglion cysts usually occur in classical anatomical areas. If a torch is pushed up against the lump, it may permit light to pass through the substance, which is called transillumination.
X-rays may be helpful in ganglions affecting the finger, as there is often osteoarthritis present.
Find out what to expect at your outpatient appointment.
Treatment for ganglion cysts
In some patients, the ganglion can spontaneously disappear and no treatment is necessary. Other patients may be reassured that the lump is benign and may choose not to have any treatment.
For patients where the ganglion is either unsightly, painful or affecting function, treatment is available.
Non-surgical treatment
It is possible to insert a needle into the ganglion and remove the jelly-like contents. This is called aspiration.
Aspiration is a minor procedure. It may confirm the diagnosis if there is any doubt and it removes the lump. The main problem with this treatment is that the lump is likely to come back in as many as 80% of cases.
Surgical treatment
Surgery is the most reliable method of removing a ganglion. This operation is called ganglion excision.
Ganglions on the finger are usually removed using local anaesthesia. Ganglions on the wrist are usually removed using either general or regional anaesthesia, where local anaesthetic is injected around the shoulder region which temporarily makes the arm numb.
The surgery is relatively minor and usually takes approximately 15 to 20 minutes. Following surgery, a light dressing is applied to protect the wound, but early active movement of the fingers and thumb is encouraged.
The dressing will remain in place for up to two weeks after the operation. It is recommended that the hand is kept dry during this period.
Read more about post-operative care.
Possible complications of surgery
There are several recognised complications following surgery, although most people do not have any problems after their operation.
- Wound infection, which occurs in approximately 1% of cases
- A visible scar, which may be tender for a period
- Stiffness of the fingers or wrist, which is uncommon
- Recurrence of the ganglion, which may occur in up to 20% of cases
Recovery after ganglion surgery
Most people recover well after ganglion surgery and the lump is permanently removed. One of the biggest problems is that the ganglion can return, which does not necessarily mean that the surgery was done badly. It most likely reflects the fact that the condition which caused the ganglion in the first place remains.
Patients can expect some discomfort from the incision for four to six weeks and discomfort from deep pressure for as long as several months. It is expected that a full recovery will be achieved within a few months after surgery.
Most people can return to normal activities within two to three weeks of surgery, although some people may restrict heavier activities for four to six weeks.
Concerned about a lump on your hand or wrist?
If you have a lump on your hand, wrist or finger, Mr Robert Farnell can assess whether it is likely to be a ganglion cyst and advise whether monitoring, aspiration or surgery may be appropriate.
Ganglion cyst FAQs
These answers are provided to help patients understand the key points about ganglion cysts, symptoms, diagnosis and treatment options.
What is a ganglion cyst?
A ganglion cyst is a benign lump which usually arises from a nearby joint capsule or tendon sheath. It is filled with a thick jelly-like substance.
Are ganglion cysts cancerous?
No. Ganglion cysts are benign and are not cancerous.
Where do ganglion cysts commonly occur?
Ganglion cysts commonly occur on the back of the wrist, the palm side of the wrist, the end finger joint or the base of the finger in the palm.
What causes a ganglion cyst?
The exact cause is uncertain. A ganglion may form when synovial fluid, which normally lubricates a joint or tendon sheath, accumulates outside the joint or tendon sheath in a cyst.
Do ganglion cysts hurt?
Many ganglion cysts do not cause symptoms. Some can be uncomfortable, painful or locally tender, particularly if they are under pressure or affecting movement.
Can a ganglion cyst change size?
Yes. Ganglion cysts classically fluctuate in size and may become bigger or smaller over time.
What is a mucoid cyst?
A mucoid cyst is a type of ganglion cyst that develops at the end finger joint. It is often associated with underlying osteoarthritis and may cause nail grooving or nail deformity.
How is a ganglion cyst diagnosed?
A ganglion cyst is usually diagnosed through clinical examination. It often occurs in a typical location and may transilluminate when a torch is pressed against it.
Can a ganglion cyst be left alone?
Yes. In some patients, a ganglion can spontaneously disappear and no treatment is necessary. If it is not painful and is not affecting function, it may be reasonable to monitor it.
Can a ganglion cyst be aspirated?
Yes. A needle can be inserted into the ganglion to remove the jelly-like contents. The main problem is that the lump may come back in as many as 80% of cases.
When is surgery considered for a ganglion cyst?
Surgery may be considered if the ganglion cyst is painful, troublesome, cosmetically concerning or affecting hand or wrist function.
What is ganglion excision?
Ganglion excision is an operation to remove a ganglion cyst. It is the most reliable method of removing the ganglion, although recurrence can still occur.