What is a Ganglion Cyst?
You haven’t injured yourself, but you’ve developed a fluid-filled sac near your wrist. What is going on?
A ganglion cyst is a typically benign (harmless) fluid-filled sac at the base of the wrist. Ganglion cysts are common, particularly among athletes between 15–40 years old. Doctors aren’t quite sure what causes ganglions, but if they are not painful and do not interfere with activity, they can often not be treated.
Some ganglion cysts go away on their own. Some hang around, aggravated by repeated use of your hand or constant connection with hard surfaces. They can be painful and make it hard to type or do perform other activities that might aggravate the cyst.
A ganglion cyst forms when a wrist joint that is under pressure produces excess fluids. These fluids stretch out the connective tissue (the ligament wall) to form a cyst just under the skin. The damaged tissue weakens at the joint capsule, and the joint fluid escapes into this weakened area, collecting into a cyst outside the joint.
Sometimes the wrist has been injured previously, and repetitive injuries, like those from tennis or golf, are commonly associated with ganglion development.
Sign & Symptoms
Ganglions can be in different areas, and they can feel very different.
If you have a mass on the back of your wrist, that could be a dorsal wrist ganglion.
If you have a mass on the wrist crease below your thumb, that could be a volar wrist ganglion. These could appear suddenly or more gradually over time. It may change size, getting bigger or smaller. There may be tenderness, and these sometimes interfere with your activities. A volar wrist ganglion can compress the median or ulnar nerve, causing issues around sensation and motion.
An occult dorsal wrist ganglion may be quite painful and tender, even though it is smaller than other ganglions. These are more challenging to identify.
- Mass / bump near the wrist
- May be painful or not painful
- May stay the same size or vary in size
- May be constant, or come and go
Diagnosis & Treatment
Any time you develop a cyst or mass, you should see a doctor to make sure it is benign. A hand examination of your hand and wrist is usually the only consultation needed to diagnose a ganglion. The only exception are occult dorsal ganglions, which are smaller and more difficult to diagnose.
If your ganglion cyst causes pain with wrist movement or contact with hard surfaces, you can have it aspirated or excised to relieve the pressure. First, though, a hand specialist will use transillumination (bright light) to determine that it is a fluid-filled cyst and not a solid mass. An MRI is sometimes used to delineate the structure of a more internal, occult cyst. Ultrasound can also help determine location, size, and other characteristics of the cyst.
Needle aspiration relieves the pressure, but in most cases, the sac refills with fluid. Excising the cyst at its root is generally the most effective permanent option. The hand surgeons at HSST are successful in the delicate extraction of ganglion cysts with low recurrence rates (under 10-15%). We may recommend open or arthroscopic surgery, depending on the location of the cyst and other factors.
Both of these outpatient procedures take 20–30 minutes and can be done with twilight anesthesia.
If we opt for treatment of your ganglion cyst, you will be protected afterward with a bulky dressing to your wrist and forearm. We encourage patients to move fingers and wrists soon after surgery, and stitches will be removed in around two weeks. Physical therapy is often recommended until normal motion comes back without pain.