GANGLION CYSTS

Definition

Ganglion cysts are noncancerous fluid-filled lumps (cysts) that most commonly develop along the tendons or joints of your wrists or hands. They may also appear in your feet.

A ganglion cyst may develop suddenly or gradually over time. The exact cause is unknown.

In most cases, ganglion cysts will cause you no pain and require no treatment. Often, they go away on their own. When you do need treatment for ganglion cysts — due to pain or interference with joint movement or for cosmetic concerns — it usually consists of removing the fluid from the ganglion cyst or surgically removing the cyst.

Symptoms

Ganglion cysts generally are:

Raised lumps near your wrist or finger joints
Round, firm and smooth
Fixed in one place but may “give” a little when you push against them
A little more than an inch (3 centimeters) in diameter
Variable in size depending on your activity level, becoming larger when you use the affected joint and growing smaller when you’re at rest
Painless, although in some cases the cysts may put pressure on the nerves near the joint, which can cause pain, weakness or numbness in your hand

Occasionally, the telltale lump that indicates a ganglion cyst isn’t visible. Often the only indication of these smaller, “hidden” ganglion cysts (occult ganglions) is pain.

When to see a doctor
If you experience a noticeable lump or pain in your wrist, hand or foot, see your doctor. He or she can make a diagnosis and determine whether you need treatment.

Causes

It’s not clear what causes a ganglion cyst to develop. It grows out of a joint, similar to a balloon on a stalk, and seems to occur when the tissue that surrounds a joint or a tendon bulges out of place. Inside the cyst is a thick, sticky fluid similar to that found in joints or around tendons.

Risk factors

Ganglion cysts are more common in women than they are in men.

The following factors also may put you at a greater risk of forming ganglion cysts:

Regular, repetitive movement that stresses your wrist or hand.
Having osteoarthritis, the wear-and-tear type of arthritis. Osteoarthritis can increase fluid within the joints, which can then leak into the tendon sheath and accumulate in an existing cyst.
Injury to the joints or tendons of your hands or feet.

Preparing for your appointment

You’re likely to start by first seeing your primary care doctor, although he or she may eventually refer you to a hand surgeon.

To get the most out of your appointment, it’s a good idea to prepare for it. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any medical conditions you have, injuries you’re recently experienced or jobs or hobbies you have that might involve stress on your affected hand or foot.
Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
Write down questions to ask your doctor.

List your questions from most important to least important in case time runs out. Some basic questions you might want to ask your doctor include:

What is likely causing my symptoms or condition?
Other than the most likely cause, what are other possible causes for my symptoms or condition? (Although there’s no clear cause for ganglion cyst, there may be factors that contribute to it, such as osteoarthritis, overuse of the affected area or injury to it.)
Do I need any tests?
Is my problem likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach that you’re suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist? (You may need to call your insurance provider yourself to get some of these answers.)
Are there any brochures or other printed material that I can take home with me? Do you recommend visiting Web sites?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you first notice the lump?
Do you have any pain or tenderness?
Is it interfering with your ability to use your joint?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?

What you can do in the meantime
If you experience worsening of symptoms with certain activities — for example, repetitive hand movements — you might want to minimize or avoid such actions, if possible. To relieve pain, consider an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

Tests and diagnosis

If your doctor suspects a ganglion cyst, these are some tests he or she may perform:

Physical exam. Your doctor may apply pressure to the cyst to test for tenderness or discomfort.
X-ray. Your doctor may also recommend an X-ray of the affected area to rule out other conditions, such as arthritis or a tumor.
Aspiration. A ganglion cyst diagnosis may be confirmed by aspiration, a process in which your doctor uses a needle and syringe to draw out (aspirate) the fluid in the cyst. Fluid from a ganglion cyst will be thick, sticky, and clear or translucent.
Other imaging tests. Your doctor may recommend ultrasound or magnetic resonance imaging (MRI) to gain information on the cyst’s size, shape and depth. MRI or ultrasound may also be used if your doctor suspects a ganglion cyst due to pain or tenderness, but the telltale swelling isn’t visible in a physical exam. In this case, an MRI or ultrasound can help locate and diagnose the “hidden” ganglion cyst (occult ganglion).

Treatments and drugs

Ganglion cysts are often harmless and painless, requiring no treatment. In fact, in many cases, doctors recommend a wait-and-watch approach before exploring treatment options.

However, if the ganglion cyst is causing pain or it’s interfering with joint movement, your doctor may recommend one of several treatment options.

Immobilization
Because activity can cause the ganglion cyst to increase in size, your doctor may recommend wearing a wrist brace or splint to immobilize the area. This helps your hand and wrist to rest, which may help the cyst decrease in size. As the cyst decreases in size, it may release the pressure on your nerves, relieving pain.

Aspiration
In aspiration, your doctor drains the fluid from the cyst. To do so, your doctor applies a local anesthetic to the area above the cyst. Then, he or she punctures the cyst with a needle and removes the fluid from the base of the cyst with a syringe. This can be done right in your doctor’s office.

Ganglion cysts may return (recur) after aspiration. In fact, the recurrence rate may be as high as 80 percent. If the cyst recurs, aspiration can be repeated. Having multiple aspirations may eventually result in no recurrence of the cyst.

Your doctor may recommend a steroid injection into the empty cyst after aspiration. Combined with aspiration, steroid injections may reduce the recurrence rate of the cyst. However, the ganglion cyst may still recur and your doctor may recommend surgery to remove the cyst.

Surgery
If you have significant pain or difficulty with joint movement, or if other treatments aren’t working, your doctor may recommend surgery to remove the ganglion cyst.

In most cases, doctors perform the surgery on an outpatient basis, which means you’ll go home the same day as the operation.

Typically, a local anesthetic is used to numb the affected area. The surgeon then makes an incision in your skin at the location of the ganglion cyst. The size of the incision depends on the size of the cyst. The surgeon will remove the cyst and the stalk that attaches it to the joint or tendon, and likely a small portion of the surrounding tissue, as well. Then the surgeon will stitch and bandage the affected area.

After surgery, you’ll be asked to keep the area elevated for up to 48 hours to help reduce swelling. You may experience discomfort, swelling and tenderness for two to six weeks. Your doctor may recommend analgesics, such as acetaminophen (Tylenol, others), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Naprosyn, others), for pain relief.

At home, you’ll need to change your bandages (dressings) as directed, and apply a topical antibiotic ointment with each change. As the incision heals, it’s important to watch for signs of infection, including redness, swelling or discharge.

In the weeks after surgery, your doctor may recommend physical therapy to rehabilitate your hand, wrist or foot.

Unfortunately, there’s no guarantee that a ganglion cyst won’t recur, even after surgery. And as with all surgeries, there are risks to be considered. Though rare, injury to nerves, blood vessels or tendons may occur. These could result in weakness, numbness or restricted motion. Your doctor can help you decide the best treatment for you.

Lifestyle and home remedies

To relieve discomfort around the ganglion cyst area, avoid repetitive motion with the affected hand or foot and refrain from activities that seem to worsen the pain.

An old home remedy for a ganglion cyst consisted of “thumping” the cyst with a heavy object. This isn’t a good solution because it causes unnecessary pain and the force of the blow can damage surrounding structures in your hand or foot. Also, don’t try to “pop” the cyst by puncturing it with a needle or sharp object. This is unlikely to be effective and can lead to infection.