Understanding Ganglion Cysts

A ganglion cyst is a benign, fluid-filled swelling that typically develops along tendons or joints, most commonly in the hand and wrist area. 1

What are Ganglion Cysts?

Ganglion cysts are the most common soft-tissue masses found in the hand and wrist 1
They are benign (non-cancerous) fluid-filled sacs that develop from joint capsules or tendon sheaths 1
Most commonly occur on the dorsal (back) or volar (palm) sides of the wrist, but can also appear on finger joints, tendon sheaths, and occasionally in other locations 1

60-70% occur on the dorsal (back) side of the wrist 2
20-30% occur on the volar (palm) side of the wrist 2
Can also develop from flexor tendon sheaths, interphalangeal joints, and extensor tendons 1
Rare types include intraosseous (within bone) and intraneural (within nerve) ganglion cysts 1

Typically appear as a round or oval lump under the skin 1
Most ganglion cysts are asymptomatic aside from the visible swelling 3
Some patients may experience:
- Pain, especially with movement or pressure 1
- Weakness in the affected area 3
- Numbness or tingling if the cyst presses on nearby nerves 3
The cyst may change in size over time - growing larger with increased activity and smaller with rest 1

Diagnosis is primarily based on history and physical examination 1
Ultrasound is appropriate for confirming the fluid-filled nature of the cyst and distinguishing it from solid masses 4, 5
The cyst may transilluminate (light passes through) when a penlight is placed against it, confirming its fluid-filled nature 1
MRI is typically reserved for suspected occult (hidden) ganglion cysts or when there's concern about solid tumors 5, 1

Approximately 58% of ganglion cysts will resolve spontaneously without treatment 3
They may fluctuate in size over time or even disappear completely 3
Recurrence is common even after treatment 3

Observation is appropriate for asymptomatic cysts, as many resolve on their own 3
Aspiration (draining the fluid with a needle) can provide temporary relief but has a high recurrence rate (15-90%) 2
Surgical excision is considered when:
- The cyst causes significant pain or interferes with daily activities 2
- The appearance is cosmetically bothersome to the patient 3
- There are concerns about the diagnosis 1
Surgical excision has a lower recurrence rate (4-39%) compared to aspiration but carries a higher risk of complications and longer recovery time 3, 2

Ganglion cysts are not cancerous and do not become malignant 1
They are not contagious 1
The exact cause is unknown, though trauma has been suggested as a possible trigger 6
They are more common in women, particularly in their 20s and 30s 6
Even after successful treatment, there is always a possibility of recurrence 3, 2