Ganglion Cysts

What are they?

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons (See Figure 1). All joints and tendons are bathed in synovial fluid. Cysts develop when the joint or tendon lining develops a weak area allowing the fluid to leak out. Ganglion cysts filled with this clear fluid or gel also maintain a stalk to the leaking joint or tendon.

The cause of a Ganglion cyst is usually unknown, although they can appear after trauma or irritation to a joint or tendon.The most common locations for ganglion cysts are:

• the back (or dorsal) side of the wrist (See Figure 2)
• the palm (or volar) side of the wrist (See Figure 3)
• the base of the finger on the palm side
• the top of the end joint of the finger on the back side

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.

How Are They 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 very firm, pea-sized nodules that are tender to applied pressure, such as when gripping.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. Ultrasound can be useful in diagnosing cysts.

What Are The Treatment Options?

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. A suction procedure can be performed to remove the fluid from the cyst and decompress it. Smaller cysts, particularly in the palm, may be “popped” by injecting them with lidocaine.The limitation of these treatments is that the sac or cyst lining is still there and can refill with synovial fluid causing the cyst to recur. 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.