Ganglion Cysts

Ganglion Cysts


Ganglion cysts are benign, fluid filled lumps that arise from joints and sometimes, from tendon sheaths. They are generally round or oval in shape and are, by far, most common in the wrist. The single most common location in the wrist is on the "back" or posterior side with the second most common location on the palm side of the wrist near the radial artery. The radial artery is where your "pulse" is usually felt. When these cysts occur near finger joints, they are sometimes referred to as mucous cysts.

Ganglion cysts can vary in size and shape and can go away occasionally spontaneously without any treatment. In general, no specific injury tends to cause ganglion cysts.

These cysts sometimes cause little or no pain symptoms, and in those cases, no treatment is indicated nor desired by patients. Commonly they cause pain after they first develop which then subsides such that patients do not wish treatment for them. In general, cysts are not removed for "cosmetic" purposes because surgery will then result in a permanent scar.

If a cyst does cause pain symptoms, then elective treatment is indicated such as needle aspiration with an option of a cortisone injection at the same time or surgery may be indicated. Sometimes anti-inflammatory medication may help some patients with the pain they sometimes cause.

With needle aspiration, the thick gelatinous fluid is sometimes difficult to pull up into a needle and syringe because it is not watery but, rather, more like the consistency of toothpaste. Needle aspiration can be offered on a trial basis for patients who do not wish surgery with the understanding that it is more likely to reoccur (or reform) after needle aspiration than after surgical removal. Needle aspiration can be performed in the office setting.

Surgery for ganglion cysts is "elective" surgery but not cosmetic surgery so it is usually covered under an individual’s health plan. The operation is done as an outpatient procedure and a commonly chosen anesthetic option includes a regional block (called a "Bier block" named after the doctor who first described the technique). This is usually combined with some IV (intravenous) sedation for patient comfort and anxiety. For most patients, general anesthesia is not necessary to perform the operation. The most common risks include infection, reoccurrence, and nerve or artery injury.

Most "office" type workers can resume their jobs within a day or two of surgery, but those who have more physically demanding jobs with use of their hands and wrists need to plan on approximately four to six weeks off work postoperatively, mainly for comfort sake.

For additional postoperative instructions and information, please see our site on home-going instructions for hand and wrist surgical patients.