Dr. Erickson's Hand Care

What is a ganglion cyst?

A ganglion cyst is a very common benign mass arising in the hand. These cysts usually arise near a joint or tendon in the hand, wrist, or fingers – the most common location is the back of the wrist (dorsal carpal ganglion) as noted in the image below. They can occur in people of all ages and are common in young adults. The cause of a ganglion cyst is unknown in most cases. One theory proposes that the cyst arises from joint fluid which has leaked from a small opening in the joint capsule. The cyst is filled with a thick, jelly-like fluid and usually has a stalk which connects with a joint or tendon sheath. Many patients report that the cyst fluctuates in size, and in some cases the cyst goes away on its own.

How is a ganglion cyst diagnosed?

Most ganglion cysts are diagnosed by history and physical exam by a physician. Since ganglion cysts are fluid-filled, a light shined directly on the mass will trans-illuminate the cyst. X-ray, ultrasound, and MRI are not required to make the diagnosis in classic cases. However, only a trained physician can determine if the cyst is benign or more worrisome.

If you have a mass, tumor, or cyst in the hand or wrist, please call the Raleigh Hand Center to request an evaluation by a hand and upper extremity specialist. 

What are the treatment options?

There are three common treatments for a ganglion cyst:

1. Observation:  Since ganglion cysts are benign (not cancer), surgery is not required to remove them. Cysts which are not painful and do not interfere with function can be left alone and observed. If the cyst becomes larger, painful, or interferes with function, further options should be discussed.
2. Aspiration:  The cyst can be punctured and the thick fluid removed using a needle under sterile conditions. This is a quick procedure which is performed in the office. There is a high chance that the cyst comes back, however, possibly over 50% of cases. There is a small risk of bleeding, pain, and infection. I do not recommend aspiration of cysts on the palm-side of the wrist (volar carpal ganglion), due to the nearby radial artery.
3. Excision:  Excision of a cyst is performed in the operating room and requires an incision. During surgery, the entire cyst is removed including the stalk which tracks down to the joint. Removal of the stalk reduces the chance of recurrence -- since the root of the problem is addressed. See below for more information. 

In the past, some physicians have recommended simply popping the cysts by hitting them with a heavy book or Bible – for this reason ganglion cysts have been called "Bible cysts." This is not recommended since damage can be done to the surrounding area and most cysts recur with this technique.

What is the recovery from ganglion cyst excision?

Ganglion cyst excision is performed on an outpatient basis. Patients may use their hands for light activities immediately, and I encourage gentle finger and thumb range of motion to help prevent digit stiffness. Most people can return to light duty work in a few days. Your wrist will be protected by a plaster splint for comfort which will be removed in clinic in 10-14 days. Occupational therapy is often helpful after this procedure to improve range of motion if your wrist becomes stiff. I recommend avoiding forceful lifting, pulling, pushing or gripping for approximately 3-4 weeks after surgery. Normal use of the hand is usually possible at 4-6 weeks post-operatively, as comfort allows. Some patients have an "ache" in the wrist for a few weeks or months after the surgery which often improves over time.

What are the complications from ganglion cyst surgery?

Possible complications include wrist pain, cyst recurrence (5-10% of patients), bleeding, infection, wrist stiffness, swelling, and damage to the surrounding joints, nerves and tendons.

Updated 11/27/2011

For additional information

Please call our office at 919-872-3171 to  make a clinic appointment. Feel free to visit these reliable websites for accurate information:

American Society for Surgery of the Hand: www.assh.org

American Academy of Orthopaedic Surgeons: www.orthoinfo.org

This material is intended for general reference only and does not replace an evaluation by a physician.