Overview
A ganglion cyst is a fluid-filled lump that develops along the tendons or joints of the wrists, hands, or feet. It is benign (non-cancerous) and contains a thick, jelly-like fluid called synovial fluid. Ganglion cysts are the most common soft tissue lumps of the hand and wrist.
How common is it?
Ganglion cysts are very common, accounting for about 50 to 70% of all soft tissue lumps in the hand and wrist. They are most common in people aged 20 to 40.
Causes and risk factors
Ganglion cysts form when fluid from a joint capsule or tendon sheath leaks out and collects in a sac. The exact trigger is unclear but joint stress, injury, or degeneration is often involved.
Common risk factors
- Joint or tendon irritation or injury
- Repetitive wrist or hand movements
- Osteoarthritis (particularly in older adults)
- Female sex (more common in women)
- Gymnasts or people with repeated wrist loading
- Previous joint injury
Symptoms
- Smooth, round, firm lump on the back of the wrist (most common site)
- Lump on the palm side of the wrist, base of fingers, or top of the foot
- May be soft or very firm
- May fluctuate in size
- Usually painless but can cause aching or discomfort
- Occasionally causes weakness or tingling if pressing on a nerve
When to see a doctor
See a doctor to confirm the diagnosis if you have a wrist or hand lump. Any painful, rapidly growing, or hard lump should be assessed to exclude rarer diagnoses.
Diagnosis
Clinical examination by an experienced clinician is usually sufficient. Ultrasound confirms the cystic nature. MRI is used if the cyst is deep or connected to deeper structures before surgery.
Treatments
Watchful waiting
Most ganglion cysts cause no significant problems and many spontaneously resolve. Observation alone is appropriate for asymptomatic cysts. Up to 40% disappear without treatment.
Aspiration
Draining the cyst with a needle under local anaesthetic provides temporary relief, but cysts recur in about half of cases as the root of the cyst remains.
Surgical excision
Removal of the cyst and its stalk provides the most permanent resolution. Recurrence rates of around 10% with surgery are lower than with aspiration.
Self-care and lifestyle
- A firm brace or splint may reduce discomfort from a painful ganglion cyst
- Activity modification to reduce wrist strain can decrease cyst size temporarily
- Do not strike the cyst with a book: this old-fashioned method can damage surrounding structures
- Monitor the cyst and return for review if it grows rapidly or becomes very painful
Prevention
There is no reliable way to prevent ganglion cysts. Avoiding repetitive joint stress may reduce risk in susceptible individuals.