It’s common – and benign
A ganglion cyst is a very common bump or mass that usually appears near joints or tendons in the hand or wrist. Common locations include the dorsal (back or top side) surface of the wrist, the palm side of the wrist, the base of the palm side of the finger, and the dorsal surface of the end joint of the finger.
You can envision what a ganglion cyst looks like by picturing a balloon filled with clear jelly, attached to a hollow stalk that comes from the joint or tendon lining. Fluid travels from the joint or tendon sheath into the stalk, and fills the balloon with fluid.
Constant motion of the hand or wrist keeps fluid pumped into the cyst and it can’t get back out. Ganglion cysts can be uncomfortable if they put pressure on nerves, tendons, or skin.
The good news is that they may go up and down in size or even go away completely on their own, without any needles or surgery. They may not be painful. Ganglion cysts are not malignant (they are not made up of cancer cells) and they don’t spread to other areas, though they may get larger or more lobulated (more lumpy). Some patients tell me they need their cyst removed because “another one popped up!” – this is usually just another lump coming from the same cyst.
How do I diagnose a ganglion cyst?
Diagnosis is based on the patient’s history (how he or she noticed the bump), where the lump is and what it feels like. Sometimes patients say they remember injuring the hand or wrist several weeks before noticing the cyst, but most patients can’t remember a specific event.
Cysts are usually round and firm. You can usually feel the smooth edges of a ganglion cyst, and you can often move the cyst around under the skin with your fingers. Cysts at the base of the finger on the palm side are usually firm, pea-sized bumps that hurt when gripping narrow objects, like a steering wheel or suitcase handle.
Putting a flashlight on the skin around the mass will make it “light up” in a darkened room (transillumination), indicating that the mass has clear fluid inside.
Cysts at the end of the finger (DIP joint cysts) near the fingernail may push on the growing nail, causing a groove in the nail. Sometimes these may drain if the skin above them gets too thin.
I usually get x-rays to look at the bones and joints around the cyst. Sometimes I can see some nearby arthritis that explains the source of the cyst fluid, but in young people there is rarely an obvious source of the mass on x-rays. Rarely a cyst will be a sign of a serious ligament injury that hasn’t been diagnosed yet.
What is the best ganglion cyst treatment?
There are non-surgical treatment options for ganglion cysts; for cysts on the wrist and cysts on the finger. The first option is to do nothing – the mass may just go away on its own. If the cyst is not painful, not limiting activity, and not too big or uncomfortable, this is a good option. A brace or splint will prevent hyperextension, the position that makes the pain worse.
Puncture or aspiration is the next thing to consider. Putting a needle in the mass may decompress it and allow the fluid inside to escape under or through the skin. Depending on where the cyst is, it may be near nerves or a major artery – make sure the doctor or nurse putting a needle in your cyst knows where these structures are.
I use the term puncture because it’s very difficult to draw out the thick clear jelly that’s often inside ganglion cysts. Usually, if the cyst is close to the skin, the jelly comes out through the hole made by the needle. The doctor may use a numbing shot first, then a larger needle to make a small hole in the wall of the cyst. I recommend a splint after this to allow the cyst wall to seal off. This is done in the office.
These days, I send patients to have these drained under ultrasound by one of our doctors who specializes in this procedure. It’s more accurate than putting a needle in blindly.
In my experience, cysts usually come back after puncture. The longer the cyst has been there, the less likely non-surgical treatment will work.
Finally, taking the cyst out in surgery is the most reliable way of getting rid of it. Ganglion cyst excision is not just a matter of opening up the skin and “lopping it off”; the joint or tendon sheath must be exposed to get out the stalk, or root of the cyst.
This can be done with a small incision over the cyst. The exact method used depends on the size and location of the mass. Recurrence rates (chances of the cyst coming back) are very low – close to 3%.
Restrictions after ganglion excision
For patients with wrist ganglion cysts, I recommend using a wrist splint after surgery for two weeks while the soreness from the surgery goes away. During that time, I advise patients to come out of the splint three times a day and do some gentle stretching exercises. Patients can type and do light activities with their hands during this time.
Activity is rarely limited after finger or tendon cyst excision. Full use is usually allowed when the skin is healed after a few days.
Watch this video for a more detailed perspective on what these wrist cysts look like:
What Dr. Henley’s Ganglion Cyst Patients Are Saying
by Harry Lynn
I was referred to Dr. Henley by my primary physician to remove a cyst on one of my fingers. From the initial visit in Bentonville to setting up the surgery at the eye clinic in Fayetteville to the follow up visit in his office, the process was simple and straightforward, and the people at each location were friendly and effective. The outpatient surgery was done at an eye surgery facility that is also used for orthopedic surgery by Dr. Henley.There the process of check in, preparation, surgery, monitoring, and check out were done very professionally by caring people who communicated well and attended to every need and answered every question we had along the way. They made sure we understood the whole process what to expect, and how we were progressing along each step of the process.
Since I was traveling soon after the surgery, we had to arrange for stitches to be removed out of state. Dr. Noel and the staff were very accommodating to help us set this up even offering to search for an appropriate place that could perform the stitch removal for us. The surgery was absolutely pain free and my only concern afterwards was how long my finger remained numb after the surgery, which Dr. Noel later explained occurs in a small percentage of patients. Dr. Noel’s friendly yet professional manner was reassuring and he answered all my questions to my satisfaction. I would definitely recommend him, the staff, and facilities used for such surgical procedures.
by Kaylie Slaughter
Dr. Henley removed a ganglion cyst from my wrist in July at North Hills Surgery Center. Dr. henley was great and explained all of my questions and concerns thoroughly. The staff at Dr. Henley’s office and North Hills Surgery Center were exceptional. The surgery was performed perfectly and my wrist is better than ever. I’m so glad I chose Dr. Henley for my surgical needs and would highly recommend him!
by Patsy Stephens
I never knew such a small thing, could cause so much pain!!! When I first noticed a little, painful knot on my right wrist, I just assumed I had bumped my wrist and the pain would eventually go away. But as time went on, the knot and the pain got bigger! I am a Real Estate Agent and it got to the point that I could not even turn a key in a lock without excruciating pain! When it became a constant pain, I knew I had to do something.
I visited Dr. Henley and he explained my treatment options. Because I really wanted to avoid surgery, we opted for a steroid shot. After a couple of weeks after the shot, my wrist was no better so I decided to have the surgery. I know to some people, a cyst on the wrist is no big deal, but surgery is surgery, no matter what! Dr. Henley and the staff at Ozark Orthopedics, as well as the Surgery Team at McDonald Eye Associates were amazing. I had the surgery to remove the cyst and my wrist was back to normal almost immediately. Thank you Dr. Henley for taking such good care of me!!