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The underlying cause of ganglion cysts is unknown but they often occur in women between the ages of 20 and 40. Although common on the wrists, they can also appear on the finger joints, around the knee and ankle joints and along the top of the foot. Ganglion cysts often feel spongy and squishy, but some can be firm and solid.

Ganglion cysts are easy to diagnose as they present very differently to bone problems or cancerous lumps. Their location near to the joints, their obvious visibility and their pliable nature make them easy to spot.

What is a ganglion cyst?

A ganglion cyst is a small lump or sack of fluid beneath the skin that forms at joints. It is particularly common to develop a ganglion cyst around the wrist behind the hand. The cyst contains a thick, jelly-like fluid similar to the synovial fluid that lubricates joints and can range in size from a small pea-like lump to a mass that can be an inch in diameter.

Why have this treated?

There is no medical reason to have treatment. Ganglion cysts are benign, they cannot spread to other parts of your body and they are not contagious. However, there are a few practical reasons for seeking medical advice:

  • The lump may look unsightly and cause embarrassment.
  • The lump may press on a nerve, compromising the function or sensation in the wrist or fingers.
  • Nerve pressure may also cause pain. This may occur locally or it can be felt as referred pain in adjacent areas.
  • The ganglion cyst may cause localised inflammation and the affected area can be sensitive to touch.
  • The cyst itself may become inflamed and painful, causing a steady throbbing sensation.

How can it be treated?

Although it is hard to believe in this day and age, the traditional treatment for a ganglion cyst was to hit it with a heavy book or bible to burst the cyst. Such cysts are often referred to as ‘bible bumps’ for just this reason. Fortunately, this method of bursting them is no longer recommended.

There are essentially three options for treating a ganglion cyst; aspiration, surgery and leaving it to heal itself. Each has advantages and disadvantages.

Aspiration

During the aspiration procedure, a small needle is inserted into the ganglion cyst and the fluid is drained out. An anti-inflammatory steroid is often injected back into the cyst site to prevent re-growth. The wrist is splinted for around a week to allow time for the site to heal.

The main advantage of aspiration is that it does not require invasive surgery. However, its success rate is not brilliant and around 50% of aspirated ganglion cysts grow back. This is because the procedure leaves the cyst wall intact, allowing it to refill from the original source over a period of time.

Surgery

Surgery to remove the ganglion cyst wall as well as the fluid within it has a much higher success rate. Only between 5% and 10% of ganglion cysts grow back after being removed completely by an operation. However, this success rate must be balanced with the risks associated with invasive surgery, particularly in the wrist as so many vital nerves and tendons pass through this area.

Surgery to remove a ganglion cyst requires a more invasive surgical procedure than most people expect. This is not just a minor operation. The surgeon must remove the cyst and often some of the underlying tissue too, such as the nerve sheath or joint lining. This is to ensure that the source of the cyst is fully dealt with.

This is why it usually takes around six weeks to recover from surgery, which can be a major inconvenience, especially if the operation is performed on your dominant hand.

Leaving it alone

In many cases, the best treatment is to do nothing. Most ganglion cysts fade with time, and even if they subsequently return, they do not really pose any serious risk to health.

During ‘flare-ups’ the cyst can be managed by a combination of standard painkillers, such as paracetemol, and ice packs to reduce swelling in area around the cyst. If movement causes discomfort, you can also splint your wrist temporarily.

So how should I deal with it?

Given the low success rate of aspiration treatment and the high risks of surgery, it is generally best to let ganglion cysts run their natural course, unless they are causing you specific problems. Most will simply go away on their own; you just need to give them time and have a little patience.

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