By Eric Strauss, MD, Hand Surgeon, Virtua Hand Surgery & Rehabilitation

If you notice that you have a swollen lump on your wrist or hand, it could be a ganglion cyst. The good news is that ganglion cysts are generally harmless and can be treated effectively by an experienced hand specialist.

What’s a ganglion cyst?

A ganglion cyst is a non-cancerous, fluid-filled sac that most commonly occurs around the joints or tendons of your wrists, hands, or fingers. Ganglion cysts also are found on your feet, ankles, and toes, though this is less common.

The size of a ganglion cyst can range anywhere from pea-sized to an inch in diameter. The fluid that fills a ganglion cyst comes from the lubrication around your joints and tendons. A ganglion cyst can be visible or hidden underneath your skin.

Most people with ganglion cysts experience no symptoms other than a swollen lump on their hand or wrist. However, a ganglion cyst sometimes can press on a nerve and cause pain, tingling, or weakness. In some cases, the size or placement of a ganglion cyst can interfere with the movement of the joints around it. 

Anyone can get a ganglion cyst, regardless of age or gender, although they’re most common among women and in adults ages 15 to 40. While most ganglion cysts have no known cause, you may be more likely to develop one if you’ve had wrist injury, or if you have rheumatoid arthritis or osteoarthritis. 

How is a ganglion cyst diagnosed?

If you have a lump that you think might be a ganglion cyst, ask your doctor to refer you to a hand specialist who will make a diagnosis and rule out other possible conditions. 

During your initial appointment, your hand specialist will review your medical history to determine how long you’ve had the cyst, if you’ve noticed any changes in its size, and if you have any symptoms such as pain or tingling. Your doctor will then conduct a physical exam, which may involve applying gentle pressure to identify tender areas. 

Your doctor also may order imaging tests to help confirm the diagnosis and rule out other conditions. MRI scans and ultrasounds can identify the tissue that makes up the cyst or find a cyst that’s below your skin. Ganglion cysts don’t appear on x-ray scans, but your doctor may order one to rule out other causes that have similar symptoms. 

What are the treatments for a ganglion cyst?

Many people who have a ganglion cyst have no symptoms and don’t require treatment. For patients who need treatment, Virtua hand specialists offer the following options: 

• Observation. If you have a ganglion cyst that isn’t causing pain, your doctor may recommend waiting to treat it. Sometimes, a ganglion cyst can go away on its own. If it persists, or your symptoms worsen, your doctor may recommend additional treatment. 
  
  
• Splinting. Moving the joints near a ganglion cyst can cause it to swell more, leading to increased discomfort. Your doctor may recommend splinting the joint near the cyst to stop aggravating it, reduce its size, and relieve symptoms. Your doctor also may give you some exercises to help strengthen your wrist as pain decreases. 
  
  
• Aspiration. If you’re experiencing severe pain or a limited range of movement, your doctor may remove (aspirate) the fluid in the cyst. Your doctor inserts a hollow needle into the cyst and then drains the fluid from it, shrinking it to relieve your symptoms. Aspiration often fails to prevent the cyst from recurring because it doesn’t eliminate the connection between cyst and joint. 
  
  
• Surgical removal. If nonsurgical treatment doesn’t relieve your symptoms, your doctor may recommend surgical removal of the cyst. During this outpatient procedure, your surgeon will make a small incision near the site of the cyst and remove it. Although it’s considered a minor surgery, the cyst may be located close to nerves or arteries. Therefore, it requires the careful precision of a skilled hand surgeon. Surgical removal is more successful at preventing the cyst from returning because it generally removes the whole cyst, including the connection between cyst and joint. After surgery, you’ll have sutures (stitches) and a dressing for ten days, followed by occupational therapy, and then at-home exercises for a few weeks to help rebuild your hand strength. 

Our goal is to work with patients to alleviate their pain, while minimizing downtime and discomfort. 

Learn more about Virtua’s hand surgery and rehabilitation program and request a consultation.