A ganglion cyst is a fluid-filled swelling that grows out of a joint capsule or a tendon sheath, and it is not cancer. Ganglion cyst treatment starts with knowing what the lump is. It is filled with a thick, clear, jelly-like fluid and is joined to the joint or tendon by a narrow stalk. It is sometimes called a bible cyst, from an old habit of striking it with a heavy book. That habit is not advised, because it can injure the wrist and the lump often returns.
Most lumps on the wrist and hand are ganglia. Other lumps do occur, so any new lump that is growing, hard, fixed or painful should be examined.
Where ganglia occur
- The back of the wrist, the commonest site, usually arising from a joint between the small wrist bones.
- The front (palm side) of the wrist, close to the pulse, where the artery lies near the cyst.
- The palm at the base of a finger, a small hard pea-like lump on the tendon sheath that hurts when gripping.
- The back of the finger near the nail, often linked to arthritis of the end joint.
- The top of the foot and around the ankle, which follow the same principles.
Symptoms
Many ganglia cause nothing except the appearance of a lump, and the size can change from week to week. Some cause an ache, especially when the wrist is bent back or loaded, or a weaker grip. A cyst that presses on a nerve can cause tingling. A small ganglion may also sit deep in the wrist with no visible lump but with pain on loading. These are sometimes called occult ganglia, and they usually need an ultrasound or MRI to find.
How it is assessed
The doctor examines the lump, its position, whether it is tender, and whether a light shone through it passes through the fluid. An ultrasound confirms that it is a fluid-filled cyst and shows its relation to nearby vessels. An X-ray is used if the wrist or finger joints show signs of arthritis, and an MRI if the diagnosis is unclear or the pain is out of proportion to the lump.
Wrist ganglion treatment: the options
A ganglion that causes no pain and is not interfering with the hand can simply be watched. Some shrink or disappear without treatment. When a decision is needed, the usual options are:
- Observation with reassurance once the diagnosis is confirmed.
- A wrist splint for a short period to settle an aching wrist.
- Open surgical removal, if the lump is painful, keeps returning, presses on a nerve, or is a concern in appearance.
Aspiration with a needle is used by some doctors, but the lump often comes back because the stalk is left in place.
Pressing, bursting or piercing the lump at home is not advised. It risks infection and does not remove the stalk.
Surgery to remove a ganglion
Dr. Aman treats a symptomatic ganglion by open surgical removal. The operation takes out the cyst together with its stalk and a small part of the joint capsule or tendon sheath it grows from. Removing the stalk is what lowers the chance that the lump returns. It is a day-care procedure under local anaesthesia, with a tourniquet to keep the area clear of blood.
The wrist is usually in a dressing or light splint for a short time, and finger movement starts early. The stitches come out at about two weeks. Light use usually returns at about two weeks, and heavy gripping usually waits until about six weeks. The scar needs time to soften.
General risks include recurrence, which can happen even after surgery, wrist stiffness, a tender or thickened scar, infection, and injury to a nearby nerve or blood vessel. Ganglia in front of the wrist lie close to the radial artery, and this is part of why they are assessed carefully before an operation is planned.
Ganglion cyst on the foot
A ganglion on the top of the foot or near the ankle often becomes a nuisance because of shoe pressure. Looser shoes, a change in lacing, or a pad that takes pressure off the lump help many people. If it keeps hurting, the same options apply as in the hand: observation, or removal with its stalk. Assessment on the foot includes checking for a nerve or tendon problem that can look like a lump.
When to see a doctor
- A lump that is growing, firm, fixed, or painful.
- A lump with numbness or tingling in the fingers.
- Pain in the wrist with no visible lump, especially when pushing up from a chair.
- A lump after an injury, which may be something other than a ganglion.
Redness, heat and fever around a lump need prompt medical care.
How to book
To book an OPD visit, use WhatsApp or the clinic and hours page, and bring any ultrasound report you have. A second opinion on a lump that has returned after earlier treatment is welcome.