A ganglion cyst is a smooth lump filled with thick, clear jelly, most often at the wrist. It is not a cancer, and it often goes away on its own. This guide explains what can be done about it, and what to expect if you choose an operation.

What is a ganglion cyst?

A is a pocket of jelly-like fluid joined to a nearby joint or tendon lining by a thin stalk. It is the most common lump in the hand and wrist, making up between half and 7 in 10 of all lumps found there1.
Ganglions appear in a few typical places:
  • On the back of the wrist. In a large study, about 6 in 10 ganglions in the arm were here2. The stalk usually leads to the joint near the , a small ligament that joins two wrist bones. A one-way valve seems to link the joint and the cyst3.
  • On the front of the wrist, on the thumb side. In an MRI study, more than half of the cysts found here lay against the radial artery, the artery you feel for a pulse4.
  • At the base of a finger. A small, firm "seed" ganglion grows from the tendon tunnel, most often where the finger meets the palm5.
  • At the end joint of a finger. This type is called a . It grows from a worn end joint, often next to the bony knobs of arthritis called 6.
Sometimes a very small ganglion causes wrist pain but cannot be seen or felt. This is called an occult ganglion7.

Who gets them?

They are more common in women. In one study, women had ganglions removed about 1.7 times as often as men8. In a large group of 1,784 people treated for ganglions, the average age was about 34, and 6 in 10 were women2.
Mucous cysts are linked with wear and tear in the finger joints. In one study, 3 in 4 people with a mucous cyst had arthritis of the finger joint on X-ray9.

What are the symptoms?

Some ganglions cause no trouble apart from the lump. Others are painful or unsightly, or make the wrist feel weak or stiff10.
A mucous cyst can press on the root of the nail. This may cause a groove or ridge in the nail9. Sometimes the nail change is the first sign of a small cyst6.

How is it diagnosed?

Usually by examination alone. A ganglion feels smooth and firm, and a light shone through it may make it glow11. An ultrasound scan or X-ray may be arranged if the lump is unusual or to check the joint underneath11. An MRI scan can find a hidden ganglion. In one study it found 83 in 100 of the hidden ganglions later confirmed at surgery12.

Will it go away on its own?

Often, yes. About half go away on their own, without any treatment13. In a study of ganglions at the front of the wrist, 20 of 39 that were left alone disappeared by themselves14.
If a ganglion does not bother you, leaving it alone is usually safe. In a long-term study of ganglions at the back of the wrist, removing or draining the lump did not give more lasting benefit than leaving it alone10.
Hitting the lump with a heavy book is an old home remedy. It is not recommended.

Treatment without surgery

Draining the cyst with a needle

The jelly can be drawn out through a needle. This is called . It is quick, but the lump often comes back. In a large review, it came back after aspiration in about 6 in 10 people15.
Adding a steroid injection does not seem to help. In a trial, aspiration with and without a steroid both worked in only 1 in 3 people. If the lump came back after one aspiration, repeating it rarely worked16.
A mucous cyst should not be pricked or drained at home. It sits over the finger joint, and an infected cyst can let infection into the joint17.

When is surgery considered?

An operation is an option when a ganglion is painful, gets in the way of work or daily life, or keeps coming back. For a mucous cyst, it is also worth considering if the skin over it is thin, it leaks, or it is damaging the nail.
Removing a ganglion lowers the chance of it coming back compared with aspiration15. For ganglions at the front of the wrist, symptoms after 2 and 5 years were the same whether the lump was removed, drained or left alone14.

What happens during the operation?

The operation is a day case. A wrist ganglion is usually removed under local anaesthetic: numbing medicine is injected around the lump, and a cuff on the upper arm stops bleeding while I work. A finger cyst is removed with numbing medicine that also reduces bleeding, so no cuff is needed.
For a ganglion on the back of the wrist, I make a cut in a skin crease over the lump, with your forearm turned palm down. The cyst is freed from the tendons and nerves around it. Its stalk is followed down to the joint, and a small window of the joint lining is removed with it. The scapholunate ligament is kept safe. The window is not stitched closed.
For a ganglion at the front of the wrist, the radial artery and a small skin nerve are found first and protected while the cyst is removed with its stalk.
A seed ganglion is removed with a small piece of its tendon tunnel, while the finger's nerves are protected.
For a mucous cyst, the cyst and its stalk to the joint are removed. The joint lining is cleaned, and the small bony spurs linked to the cyst are trimmed. When the joint is dealt with like this, the cyst comes back in very few people18. The root of the nail, where the nail grows from, is protected throughout.
In a study of 429 wrist ganglions, the laboratory agreed with the surgeon's diagnosis in 98.6%19. So the tissue is sent for testing only if the jelly looks unusual.
At the wrist, the skin is closed with a dissolving stitch under the skin and paper strips. On the finger, fine stitches are used and removed later.
Some surgeons remove wrist ganglions through keyhole surgery. In a trial, the lump came back about as often after keyhole surgery as after open surgery20. In a review of studies, keyhole surgery allowed a quicker return to work but took longer to do21. We can talk about it as an alternative.

Recovery

You go home the same day with a soft dressing. Usually there is no splint.
  • Keep the hand raised when you can. Move your fingers and wrist straight away, and use the hand for light tasks from the first day.
  • Take regular paracetamol and an anti-inflammatory for the first 2 to 3 days, if they are safe for you.
  • The wound is checked at 10 to 14 days. Paper strips at the wrist come off then, and finger stitches are removed.
  • After a mucous cyst, keep the finger dry until the wound check. The end joint is usually left free to move.
  • Most people return to desk work within the first week, and to manual work after about 2 weeks.
  • You can drive when you can grip the wheel comfortably and are off strong painkillers, usually within 1 to 2 weeks.
  • I see you in clinic 6 weeks after the operation.

How well does surgery work?

In a long-term study, people were more satisfied after removal than after aspiration or no treatment, even if the lump came back10.
A ganglion can still come back after it is removed. In a large review, a wrist ganglion came back after open surgery in about 1 in 5 people15. In another study of over 1,000 wrist ganglions, 13 in 100 people who answered a survey reported a lump again, but few needed a second operation22. A lump that comes back usually shows within the first year or two.

What are the risks?

In the large review, about 14 in 100 people had a complication after open surgery15. Risks include:
  • a lump that comes back;
  • a tender or thick scar;
  • numbness or a painful spot from a small skin nerve;
  • stiffness of the wrist;
  • infection or bleeding, as after any operation.
Injury to the scapholunate ligament, causing a loose wrist, has been reported but is very rare23.
At the front of the wrist, the radial artery and small nerves lie close by. In one small study, complications were more common after removing ganglions here than on the back of the wrist24.
After a mucous cyst, risks include stiffness of the end joint, a new nail change, infection, and the cyst coming back. In one study, 17 in 100 lost a little straightening of a finger joint, 7 in 100 developed a new nail change, and 3 in 100 had the cyst come back. A nail change present before surgery went away in 6 in 1025.
Complex regional pain syndrome is a recognised risk of hand surgery. It causes pain, swelling and stiffness that seem out of proportion. Tell your surgeon early.

When to seek help

See your GP, or go to the emergency department, if you have:
  • a fever, or spreading redness, warmth or discharge at the wound;
  • pain or swelling that gets worse instead of better after the first few days.
See your GP if a mucous cyst leaks fluid, or if the skin over it becomes red or sore. Also see your GP if any lump grows quickly, feels hard, or does not look like a typical ganglion. Your GP can refer you to a hand surgeon. Return to the clinic if the lump comes back after surgery.

Summary

A ganglion cyst is a common lump filled with jelly, most often at the wrist. It is not a cancer. About half go away without treatment, and leaving one alone is usually safe. Needle drainage is simple, but the lump often returns. Removing it is a day-case operation under local anaesthetic, but about 1 in 5 wrist ganglions come back after open surgery. A mucous cyst rarely comes back when the finger joint is cleaned at the same time.