What is a ganglion cyst and how do they occur?
A ganglion cyst is the most common benign (i.e. non-cancerous) tumor of the hand and wrist. These cysts occur adjacent to tendons and joints are are filled with a thick, jelly-like substance called mucin. While the exact cause of these cysts is unknown, they are thought to form secondary to irritation of tendons and joints that may occur in the setting of trauma. When they occur around the joint, it is thought that they occur because of a one way valve mechanism whereby joint fluid can exit the joint, but cannot return back into the joint, thereby causing fluid to accumulate as a cyst outside of the joint.
If big enough, the patient can notice a firm and round mass that may or may not be painful or tender to the touch. Ganglion cysts can be found near any joint in the body, but are most commonly located on the back of the wrist, and also commonly found on the palmar aspect of the wrist. When ganglion cysts occur on the palm side of the fingers, they are known as Retinacular Cysts, and are usually very firm and pea-sized. Ganglion cysts may also be found on the top aspect of the finger joint closest to the fingernail, called Mucous Cysts, and are discussed in further detail elsewhere. Ganglion cysts frequently fluctuate in size.
An x-ray is often ordered to evaluate for problems within the just such as arthritis. Ultrasound may furthermore be performed in clinic to confirm that the mass has features consistent with a cyst. An MRI may also be ordered to confirm the diagnosis and get a better idea of the exact location of the cyst prior to surgery (if needed).
Non-operative treatment is usually the first line approach and often just consists of observation. This is especially true for cysts that are small and causing little to no symptoms or cosmetic deformity. Needle aspiration of the cyst may be attempted for larger or more symptomatic cysts. Aspiration is perfumed by sticking a small needle into the center of the cyst and sucking out its contents. This is often accompanied by a Cortisone flush which may reduce recurrence. While aspiration works for some people, the recurrence rate of the cyst is high (roughly 50%)
Surgery is normally recommended for cysts that continue to be symptomatic despite aspiration or cysts that are unable to be aspirated (some cysts are in difficult locations and must be removed surgically) and causing the patient ongoing pain and functional disability. Surgery usually takes less than 15 minutes, and consists of a small incision and removal of the cyst. It is important to note that although rare, cysts can still recur despite surgery. Learn more about scheduling surgery.
The patient's dressing and splint will need to remain on until the first follow-up appointment, 1-2 weeks after the surgery. We advise against any forced gripping or lifting anything heavier than the weight of a coffee cup during this time. The first post-op appointment usually consists of suture removal and placement into a more comfortable splint for another week. Keep in mind that we may delay taking out your sutures if it looks like your wound requires more time to heal. Occupational Hand Therapy is usually started one week after your first post-op appointment. It is at this time that patient's are usually allowed to wean down use of their splint. Occupational therapy is usually only continued for 4-6 weeks (possibly longer in some patients). Learn about more about post operative care.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.