Ganglion cyst 

  • Overview

Introduction 

Illustration of a ganglion cyst

Excicison of ganglion

 

  1. Wrist
  2. Ganglion cyst

 

Will the cyst disappear if I hit it with a heavy object?

In the past, the tradition was to bash a ganglion with a heavy book to break the cyst open and release its contents. This was a drastic remedy and is no longer recommended.

A ganglion cyst is a fluid-filled swelling that develops near a joint or a tendon. The cyst can range from the size of a pea to the size of a golf ball.

Ganglion cysts look and feel like a smooth, soft lump under the skin. They are made up of a thick, jelly-like fluid, called synovial fluid, which surrounds joints and tendons to lubricate and cushion them during movement.

Ganglions can occur alongside any joint in the body, but are most common on the wrist (particularly the back of the wrist), hand and fingers.

Ganglions are generally harmless, but they can sometimes be painful, especially if they are next to a nerve. If they do not cause any pain or discomfort, they can be left alone and may disappear without treatment, although this can take a number of years.

It is not clear why ganglions form, but they may be related to ageing or injury to the joint or tendon. They occur when the synovial fluid that surrounds a joint or tendon leaks out and collects beneath the skin.

Treatment options

Treatment is usually only recommended if the cyst causes pain or affects the range of movement in a joint.

The two main treatment options for a ganglion cyst are:

  • draining fluid out of the cyst with a needle and syringe (the medical term for this is aspiration)
  • cutting the cyst out by way of surgery

Availability on the NHS

Most clinical commissioning groups (CCGs) do not fund treatment for ganglion cysts unless they cause significant pain or disrupt daily activities.

If you want to have a cyst removed for cosmetic reasons, you will probably have to pay for private treatment.

Aspiration

Aspiration is carried out under local anaesthetic (where the area is numbed), usually in the outpatient department of your local hospital or GP surgery.

The skin over the lump is cleaned and numbed with a small local anaesthetic injection. Your doctor will remove as much of the contents of the ganglion as possible with a needle and syringe.

The area is sometimes also injected with a dose of steroid medication to help prevent the ganglion returning, although there is no clear evidence that this reduces the risk of recurrence.

After the procedure, a plaster is placed over the small hole in your skin, which can be removed about six hours after the procedure.

Aspiration is a simple and painless procedure and you will be able to leave the hospital or surgery straight afterwards. It is often the first treatment option offered for ganglion cysts as it is less invasive than surgery.

However, around half of all ganglion cysts treated using aspiration will return at some point. If a cyst does return, surgery may be necessary.

Surgery

There are two ways that surgery can be used to remove a ganglion cyst:

  • open surgery – where the surgeon makes a medium-sized cut, usually about 5cm (2 inches) long, over the site of the affected joint or tendon
  • arthroscopic surgery – a type of keyhole surgery where smaller incisions are made and a tiny camera, called an arthroscope is used by the surgeon to look inside the joint. Using the arthroscope as a guide, they then pass instruments through the incision to remove the cyst

Both techniques can be performed under either local or general anaesthetic, depending on where the ganglion is, which anaesthetic you would prefer and what your surgeon thinks is best.

Having a local anaesthetic means that you will be awake but will not feel any pain. Having a general anaesthetic means that you will be asleep during the operation.

Open or keyhole surgery?

Both techniques are equally effective in removing the cyst and reducing the risk of it returning.

Keyhole surgery tends to cause less pain after the operation, but waiting times are often longer.

After the operation

The surgeon will stitch up the wound and a bandage will be placed over the area. This helps keep the area clean, reducing the risk of infection, and safe from any accidental bumps. The wound is not usually painful, but you will be given painkillers to take if you feel any discomfort after the operation.

If the cyst was removed from your wrist or hand, you may need to wear a sling for the first few days. This will help keep your arm safe from any accidental knocks and may help reduce swelling and discomfort. Move your fingers regularly to help keep the joints flexible.

Surgery to remove a ganglion cyst will leave a scar that can occasionally be thick and red. For some people, the skin around the scar remains numb after the operation.

It is likely that you will experience some bruising in the area after your operation, but this should fade quickly. There is also a small possibility of temporary stiffness, swelling or pain afterwards. This may be caused by a minor infection that can be treated using antibiotics. Lasting pain or stiffness may need further treatment with physiotherapy.

How much time you need to take off work after surgery to remove a ganglion cyst will largely depend on your job. If you job involves manual labour, you may need to take several weeks off. Most people are able to start driving again about two to four weeks after surgery.

Complications

Having a ganglion cyst removed is a minor procedure, so complications are rare and seldom serious. However, a small number of people experience permanent stiffness and pain after surgery.

If you have the operation under general anaesthetic, there is also a very small risk of complications to your heart and lungs. Pre-assessment tests before surgery should make sure that your risks are as low as possible.

There is always a chance that a ganglion cyst will come back after treatment. It's estimated that between one and four in every 10 cysts that are surgically removed will return. The cyst can be removed again with a good chance of success the second time round, although having further surgery does increase the risk of complications, such as damage to nearby nerves.

Page last reviewed: 12/09/2013

Next review due: 12/09/2015

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Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Butterfly8i8 said on 16 July 2014

I had one for ages before I knew what it was, it was on the inside of my index finger on my left hand and it was quite large before it was diagnosed as a ganglion. I went to a walk in centre as it was starting to really ache when I was holding things like shopping bags and mugs of tea. I got diagnosed and then referred to a specialist at the hospital. They said the only answer was surgery but warned that it might come back. I went in, had it removed and felt a bit ill afterwards as I had a local and got a bit angsty in theatre as it was a big one and in a place that the surgeon hadn't seen before. That's not want you want to hear really...
I had it done on the 9th of December 2009 and had my stitches out just before New Year 2010. The scar looked a bit funny as its a v shape, but it no longer hurt. It hasn't come back either. However, I think I now have one on the other hand on my main thumb joint which is making working on a computer all day very difficult. But if the Drs diagnose me again, I wouldn't say no to surgery, as it worked so well last time. and is likely to be the only course of action.

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Sassmin said on 08 May 2014

I'm 18 and I have had my ganglion for around 5 years or more. It's on my right wrist which is awful because it's my writing hand and the slightest movement makes it ache...I had it drained a couple of years ago but now it's back twice as bad. Some days it's smaller and others it's huge and very painful...I'm hoping to get it drained again next week as the pain is starting to get too much!

My ganglion appeared when I first ever started roller skating, I fell on my wrists on to the floor which was obviously a nasty fall...

Most of the time I forget it's there! But as I have a lot of writing to do recently the pain is awful.

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Amberlouise said on 23 March 2014

Hi i went to doctors with a gangolian cyst top of my wrist now I have another 2 more weird lumps Witch come up more if I move my thum or hand one is abit lower than the gangolian cyst and other one is on left hand side Witch comes up when I move my hand it looks under skin rather than on top like the Ganglion. Could it be the same thing can u get more than one on your wrist?

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tayatygarfield said on 11 January 2014

hello i am glad i found this page i am having some complications i just had a ganglion cyst removed from my left foot on my fiisrt metatarcal bone the incision is about inch and half long and its one long stitch the doctor did not give me crutches but i have been staying off it elevating it icing it using naproxen and tylenol for pain i am also taking antibiotic however i am experiencing severe pain its really swelling and red i also just noticed a little bubble of pus i can hardly walk on it its horrible should i go to er its a weekend and cant reach my doctor

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Ridge Detail said on 03 December 2013

Hi all, I have a ganglion cyst on the back of my hand/wrist it is about 2-3 cm in diameter, it's sore most times and have been told that surgery isn't likely to be successful. I've had ultrasound therapy at my hospital's physio dept and this has helped with the pain. I've since got a home ultrasound kit and this has helped me a lot. My ganglion comes and goes, seems worse when the weather is cold. After the ultrasound I am nearly back to normal for at least the full day. Fingers crossed it goes on its own.

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dk83 said on 11 November 2013

Hi all, I had a ganglion removed via surgery about a year and a half ago in my home country - this was after an unsuccessful aspiration attempt. The ganglion has now come back in exactly the same place and has been growing over the last 6 months or so. Though I do not experience the very severe symptoms that some of you mention, it has still got so big that I feel it beginning to press on the surrounding area, which is very uncomfortable. I also feel that there are things I cannot do and have to be careful what I use my left arm for all the time - such as push open a door, for instance. I recently spoke to my GP who basically refused to refer me to an NHS consultation because I wasn't being kept awake at night by the pain. Is this really the level it has to get to before you can get a referral or is it worth getting a different GP's opinion? Many thanks!

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wendywasp said on 13 May 2013

I had an operation 5 weeks ago to remove my ganglion but it came back more-or-less straight away and it is so painful. It wakes me up every night (if I don't take pain killers) and I cannot get back to sleep as the pain is so intense. It's in my wrist, right up to my elbow and to my finger tips. I just don't know what to do with my hand in the middle of the night and I don't know what the solution is. I am basically living on pain killers at the moment.

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Kittensox said on 29 April 2013

I am 18 years old and really ever since I went away to a watersports college 2 years ago I have had a ganglion appear on my left hand and I no longer what to do because it has become to painfull on occasions that it is strating to hamper my performance on the water and when i spoke to a local gp where i live all they did was perscribe some ibroprofine gel to rub on it.
the gell doesn't really help with the pain and it doesn't make the ganglion go away either i was told that i could have the fluids drawn out my a needle and then told if that doesn't work then think about surgery but I can't afford to loose that amount of time for healing and then I was told it could make things worse and the thing might keep comming back any way!!

Please if any one has a suggestion as to how to get rid of it then I would love to know
Please anf Thank you

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lunalinna said on 28 April 2013

I had surgery on my left wrist over ten years ago to remove a ganglion and the recovery process was pretty painful. Now I have one in my right wrist and panic stricken. The pain and numbness has become worse in the last six months as the numbness now goes all the way up my arm and sometimes into my armpit. It disrupts my sleep and even when I am not sitting at my desk, I can be in the car and my hand and forearm are so numb it's painful. I know at this point the only option is surgery, but don't want to be out of work for weeks!

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BipptyboppityBoo said on 18 March 2013

I'm due to go in this week to have a ganglion cyst removed from the base of my finger. I'm trying to work out how much of a bandage will be on my hand afterwards? I work in a Day Nursery so am trying to think I'll be off work for at least 3 weeks as I do heavy lifting and when working with little ones would be more prone to infection. I wasn't worried about the pain until I read the post above, so now I'm nervous lol.

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