What is a ganglion cyst?

Understanding Ganglion Cysts

A ganglion cyst is a benign, fluid-filled sac that most commonly develops along the tendons or joints of the wrist or hand, appearing as a lump under the skin. 1

Key Characteristics

• Ganglion cysts are the most common soft-tissue masses found in the hand and wrist 1
• They typically contain a clear, jelly-like fluid 1
• Most commonly found on the dorsal (60-70%) or volar (20-30%) aspects of the wrist 2
• Can also occur in other locations including:
  • Finger joints 3
  • Flexor tendon sheaths 1
  • Extensor tendons 1
  • Within tendons (intratendinous) 4

Causes and Risk Factors

• The exact cause remains unknown, though trauma has been suggested as a possible trigger 3
• More common in women, particularly in their twenties and thirties 3
• May develop from joint or tendon irritation, causing the tissue to bulge outward 1

Symptoms

• Many ganglion cysts are asymptomatic aside from the visible lump 5
• Possible symptoms include:
  • Pain, particularly with movement or pressure 1
  • Weakness in the affected area 1
  • Numbness or tingling if the cyst presses on nearby nerves 1
  • Limited range of motion 2

Diagnosis

• Primarily diagnosed through physical examination 1
• Transillumination (shining a light through the cyst) can help confirm it's fluid-filled 1
• Ultrasound is recommended to confirm the cyst is fluid-filled rather than solid 6
• MRI may be used if:
  • The diagnosis is uncertain 6
  • The cyst is not visible but suspected (occult ganglion) 6
  • There's concern about a possible solid tumor 1

Natural History

• Approximately 58% of ganglion cysts will resolve on their own without treatment 5
• Some may fluctuate in size over time or disappear and recur 1

Treatment Options

• Observation is appropriate for asymptomatic cysts, as many resolve spontaneously 5
• Non-surgical options:
  • Aspiration (draining the fluid) can provide temporary relief but has high recurrence rates (15-90%) 2
  • Warm compression is not recommended as it lacks evidence of effectiveness 6
• Surgical excision:
  • Considered when pain and functional limitations affect daily activities 2
  • Has lower recurrence rates (4-9%) compared to non-surgical treatments 2
  • Complete removal of the cyst and its stalk is important to prevent recurrence 2
  • Recovery may take several weeks 5

Important Considerations

• Ganglion cysts are not cancerous and do not become malignant 1
• If the cyst is not causing symptoms, treatment may not be necessary 5
• Even with surgical removal, there is still a possibility of recurrence 2
• Surgical excision has a higher complication rate and longer recovery period compared to non-surgical approaches 5