Ganglion Cyst Surgery
Ganglion cysts are benign, gel-filled swellings arising from a joint or tendon sheath in the wrist and fingers. They can be removed surgically if they cause pain or problems.
A ganglion cyst is the most common soft tissue swelling of the hand and wrist. It arises from a joint capsule or tendon sheath and is filled with a thick, jelly-like fluid. It is benign and does not turn into cancer. Its size can change over time, and it sometimes shrinks and disappears on its own.
Where does it occur?
- Back of the wrist: The most common site
- Palm side of the wrist: Near where the pulse is taken
- Base of a finger: Small, firm cysts from the tendon sheath
- The joint near the fingertip: Mucous cysts, usually with arthritis of that joint
Symptoms
- A round swelling, soft or firm
- Often painless
- Pain may occur when loading the wrist, gripping or pushing up
- Numbness or weakness if it presses on a nerve
- Pain when gripping with cysts at the base of a finger
Diagnosis
The diagnosis is usually made on examination. Shining a light through the cyst can show that it is filled with fluid. Ultrasound shows its connection to the joint and its contents and helps distinguish it from other lumps. MRI may be used for hidden cysts that cannot be felt.
Treatment options
Monitoring
Cysts that are painless and do not affect daily life need no treatment. Some shrink on their own over time.
Aspiration
The fluid can be drawn off with a needle. It is quick and simple, but because the root of the cyst stays in place, recurrence is common.
Surgical removal
Surgery is recommended for cysts that are painful, growing, pressing on a nerve or recurring after aspiration. The cyst is removed together with its root in the joint or tendon sheath, which lowers the chance of recurrence. An arthroscopic technique can be used in suitable patients.
What to avoid
Trying to burst the cyst by hitting it with a hard object is not recommended. It can damage surrounding tissue and the cyst usually returns.
Recovery
The wrist is protected briefly after surgery, followed by movement exercises. Returning to daily activities takes a few days to a few weeks. Stitches are removed after about two weeks.
Why do ganglion cysts form?
The exact cause is not fully known. The most accepted view is that joint fluid leaks through a small weak spot in the joint capsule or tendon sheath and is walled off by a capsule, forming the cyst. Because the connection to the joint works like a one-way valve, fluid collects inside the cyst. Joint or tendon injuries, work that repeatedly strains the wrist and arthritis can all contribute. Cysts are more common in women and between the ages of 20 and 40.
Hidden ganglion cysts
Some ganglion cysts are very small and cannot be felt from outside. These hidden cysts can cause pain, especially when bending the wrist back or pushing up on the hand. In patients with unexplained wrist pain, ultrasound or MRI can reveal them.
Cysts at the fingertip
Mucous cysts on top of the joint near the fingertip usually develop because of arthritis in that joint. The cyst can press on the area where the nail grows and cause grooves in the nail. When the skin over the cyst thins, it can burst on its own and carry a risk of joint infection. Treatment is therefore recommended for mucous cysts with thinning skin. Surgery removes the cyst together with bone spurs in the joint.
Aspiration or surgery?
Aspiration is quick and simple and can give lasting relief in some patients, but because the root stays in place, recurrence is common. Surgical removal reduces the chance of recurrence but involves an operation and recovery. The choice is made together, based on the cyst’s location and size, the symptoms and the patient’s preference. Because important blood vessels lie around cysts on the palm side of the wrist, procedures there are planned carefully.
After surgery
In the first days the hand is kept raised and the fingers are moved. The incision should be kept dry until it heals. Wrist movement is increased gradually, and heavy lifting and wrist-straining sport are postponed for a few weeks.
Frequently asked questions
Is a ganglion cyst dangerous?
No. It is benign and does not turn into cancer. An examination is still important to tell it apart from other lumps that can look similar.
Can it come back after surgery?
Removing the root reduces the chance of recurrence, but it is not zero.
My cyst gets bigger and smaller. Is that normal?
Yes. The size of ganglion cysts can change depending on how much the hand is used.
Does a ganglion cyst go away on its own?
Some cysts shrink or disappear over months or years. If it causes no problems, waiting is a reasonable option.
Can my cyst press on a nerve?
Some cysts, especially on the palm side of the wrist or in Guyon's canal, can press on nerves and cause numbness and weakness. Treatment is then recommended.
Will there be a scar?
The incision is usually made along skin creases and fades over time.
Do children get ganglion cysts?
Yes. They can occur in children and often disappear on their own, so monitoring is usually advised first.
Why is my cyst growing if it doesn't hurt?
The amount of fluid in the cyst can rise and fall with hand use. Growth alone is not a danger sign, but rapid growth or pain should be assessed.
What is arthroscopic ganglion surgery?
Some cysts on the back of the wrist can be removed through small holes using wrist arthroscopy. Suitability depends on the cyst's location and structure.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.