Ganglion Cyst

What Is a Ganglion Cyst?

A ganglion cyst is a small sac of fluid that forms over a joint or tendon (tissue that connects muscle to bone). Inside the cyst is a thick, sticky, clear, colorless, jellylike material. Depending on the size, cysts may feel firm or spongy.

Ganglion cysts, also known as bible cysts, most commonly show up on the back of the hand at the wrist joint but they can also develop on the palm side of the wrist. They can also show up in other areas, but these are less common:

• The base of the fingers on the palm, where they appear as small pea-sized bumps
• The fingertip, just below the cuticle, where they are called mucous cysts
• The outside of the knee and ankle
• The top of the foot

Ganglion Cyst Symptoms

Symptoms of a ganglion cyst can include:

• A soft bump or mass that changes size but doesn’t move.
• Swelling that may appear over time or suddenly.
• It may get smaller in size or even go away and come back.
• One large cyst or many smaller ones may develop, but they are usually connected by deeper tissue.
• Some degree of pain is possible, especially after acute or repetitive trauma, but many aren’t painful.
• Pain may be chronic and get worse with joint movement.
• When the cyst is connected to a tendon, you may feel a sense of weakness in the affected finger.

The below image shows a traumatic ganglion cyst. This person came to the emergency department with a painful bump after the wrist was hit by a car door.

The image below shows the jellylike fluid taken from the cyst in the above image. Its presence confirms the diagnosis of a ganglion cyst.

An ultrasound image below shows the ganglion cyst (area between markers).

The below image shows a ganglion cyst that has been operated on in the past. This ganglion returned because this person plays the cymbals in their school band.

Ganglion Cyst Causes and Risk Factors

The cause of ganglion cysts is not known. One theory suggests that trauma causes the tissue of the joint to break down, forming small cysts that then join into a larger, more obvious mass. The most likely theory involves a flaw in the joint capsule or tendon sheath that allows the joint tissue to bulge out.

Ganglion cysts are more common in women, and 70% occur in people between the ages of 20-40. Rarely, ganglion cysts can occur in children younger than 10 years.

Ganglion Cyst Diagnosis

If you have a bump, you should see your doctor, even if you don’t have symptoms that bother you. A physical exam is often all that is needed to diagnose a ganglion cyst.

• Your doctor may get further confirmation by using a syringe to draw out some of the fluid in the cyst (needle aspiration) or by using ultrasound. An ultrasound picture is made as sound waves bounce off of different tissues. It can determine whether the bump is fluid-filled (cystic) or if it is solid. Ultrasound can also detect whether there is an artery or blood vessel causing the lump.
• Your doctor may send you to a hand surgeon if the bump is large or solid or involves a blood vessel (artery).
• MRI is used to see the wrist and is very useful for ganglions. One drawback to this diagnostic method is the cost of the procedure.

Ganglion Cyst Treatment

A ganglion cyst doesn’t need emergency treatment unless you have significant trauma. A routine check by either your doctor or a specialist in bones and joints (an orthopedist) is often enough.

Self-care at home

If your cyst isn’t bothering you, your doctor may tell you to keep an eye on it and be in touch if anything changes. Many cysts can disappear without any treatment at all.

In the past, home care for these growths included topical plaster, heat, and various poultices. It even extended to use of a heavy book to physically smash the cyst. These forms of treatment are no longer suggested, because they have not been shown to keep the ganglion cysts from returning and could, in fact, cause further injury.

Medical treatment

If your cyst is bothering you, your doctor may recommend one of these treatments:

• Aspiration: With this procedure, a needle is placed into the cyst to draw the liquid material out. Then a steroid compound (anti-inflammatory) is injected into the area and the area is put in a splint to keep it from moving. Aspiration doesn’t remove the area that attaches the cyst to the joint, so they often return.
• Surgery: With this procedure, the doctor removes the cyst and the area around it that attaches it to the joint. Your doctor may recommend surgery if aspiration hasn’t helped and the mass is painful, it interferes with function (especially when your dominant hand is involved), or it causes numbness or tingling of the hand or fingers.

Next Steps Follow-Up

After you have been diagnosed with a ganglion cyst and have chosen to have treatment, follow-up will be different based on what you have chosen to do.

• After simple aspiration, your doctor may ask you to start moving the joint soon after the procedure.
• Most likely after surgery, your joint will be splinted for up to 7 to 10 days. A splint is a hard wrap that will keep you from moving your joint.
• Studies show that splinting for a long period of time doesn't really help, so you may be encouraged to use the joint soon afterward.
• Your doctor may ask you to return for a checkup after your surgery and will decide if physical or occupational therapy is needed. Follow-up care will be based on your personal needs.

Ganglion Cyst Prevention

Because the cause of a ganglion cyst is not known, it is difficult to tell how to prevent them. Early evaluation and treatment are recommended.

Ganglion Cyst Outlook

Because this is a tumor that can go away on its own, or after a simple needle aspiration or minor surgery, chances are good that you will have a full recovery. Because ganglion cysts may come back after any of these treatments, however, a single treatment may not be enough.

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