Most of the ganglion cysts are asymptomatic and sometimes remain undetected for long. They normally appear like a small bump, that changes in size, and usually does not move. They are normally pea sized, round or oval, an average size being about 2 cm, but their size can vary to as large as a golf ball. Cysts larger than 5 cm normally have to be surgically excised. Some cysts may appear suddenly and resolve spontaneously.

Ganglion cysts are normally painless unless they compress the adjacent nerve fibre, or restrict joint movement which results in dull aching continuous pain. Sometimes when the ganglion cyst gets attached to a tendon, it can also present with tingling numbness and muscle weakness. The cause of pain is unknown and is mainly due to adjacent nerve compression, though the most common presentation of the patient would be a non tender swelling or a mass. They never spread to other parts of the body. Along with pain, there may be slight limitation of movement of the affected joint.

• Pain

  They may or may not be painful. If painful, the pain may be continuous and worsen with the movement of the joint. [draguskadir.com.au]

  However, if the cyst growth presses on the nerves nearby, ganglion cysts can cause muscle weakness, tingling and pain. Even without causing pain, larger cysts may cause appearance concerns. [seton.net]

  But if the cyst is causing pain or complications, it can be aspirated (drained) with a hypodermic needle or removed using arthroscopic surgery. Back in the Game patient stories [hss.edu]

  As pain decreases, your doctor may prescribe exercises to strengthen the wrist and improve range of motion. Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it. [orthoinfo.aaos.org]

• Swelling

  The prognosis of these swellings varies and chances of reappearance of these swellings are high. Normally these harmless tumours go away by themselves or may require a simple surgery. [symptoma.com]

  Ganglions are not always visible in that some do not bulge upwards through the skin, but swell inwards. Here, especially, the diagnosis must be carried out using ultrasound and CRT scans. [baur-fromberg.de]

  Ultrasound examination revealed a cystic swelling filled with hemorrhagic fluid with an hourglass appearance. [ncbi.nlm.nih.gov]

  Ganglion cysts are the commonest type of swelling in the hand and wrist. [bssh.ac.uk]

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

• Weakness

  If the cyst is attached to a tendon, you might feel weakness in the affected area, or if it compresses a neighbouring nerve, you may experience a tingling sensation, pain and muscle weakness. [draguskadir.com.au]

  Ganglions usually occur due to a weakness in the covering of a tendon or joint space. [footmechanicspodiatry.co.nz]

  However, when cysts grow large enough to cause tingling, pain and muscle weakness, surgery may be necessary. Contact us online today to learn more about your treatment options for ganglion cysts. [seton.net]

  Although there was no recurrence at 30-month follow-up, there was no significant improvement of the tongue weakness. We describe our surgical strategy and discuss the pathogenesis of the cyst. [ncbi.nlm.nih.gov]

  As a rule, however, it is a hereditary weakness of the capsular ligament, which often appears in young women during puberty. Occasionally there is a type of ganglion that results from trauma after a tear to the capsule or tendon sheath. [baur-fromberg.de]

• Inflammation

  The exact cause of ganglion cysts is unknown but may be caused by arthritis, joint inflammation or trauma. Ganglion cysts most often develop at the center of the back of the wrist and on the palm side of the hand near the base of the fingers. [emoryhealthcare.org]

  Icing the ganglion for 15 to 20 minutes may temporarily help with inflammation and pain. If your inflammation is severe, your healthcare provider may treat your symptoms with medicine. [oregon.providence.org]

  Icing the ganglion for 15 to 20 minutes may relieve inflammation and pain for a short time. If inflammation is severe, your healthcare provider may treat your symptoms with medicine. [fairview.org]

  They are believed to result from weakness of the joint capsule, ligaments or tendon sheath, which may be inherited or may be caused by arthritis, joint inflammation or trauma. [centralcoastortho.com]

• Surgical Procedure

  A special surgical procedure was also presented here using a modified preauricular incision and transcondylar approach for extracapsular dissection of both lesions. [ncbi.nlm.nih.gov]

  If the cyst keeps returning, surgery may be recommended to remove the cyst via a surgical procedure known as Ganglion Cyst Removal. Our hand surgeons at Emory will discuss the best treatment option for you. [emoryhealthcare.org]

  Surgical treatment has been well described both as an open surgical procedure (through a skin incision) and as an arthroscopic procedure. Different surgeons have preferences for their favored approach. [verywellhealth.com]

  Artificial finger joint replacement is a surgical procedure that involves the removal of an arthritic or damaged finger joint and replacement with an artificial prosthesis. [fondren.com]

  Possible Complications Overall the surgical procedure is a safe and without complications. However, as with any surgical procedure there are possible complications. [ahni.com]

• Aspiration

  Removing cyst fluid The first option is to drain the cyst by removing the fluid, which is called aspiration. The skin overlying the cyst is anesthetized and the cyst is aspirated with a needle and the fluid evacuated. [muirortho.com]

  The diagnosis is confirmed by needle aspiration or ultrasound. Needle aspiration is a process where some amount of the fluid in the cyst is withdrawn using a sterile needle and sent for examination to the laboratory. [draguskadir.com.au]

  Aspiration. If the ganglion causes a great deal of pain or severely limits activities, the fluid may be drained from it. This procedure is called an aspiration. [orthoinfo.aaos.org]

  This is called aspiration, and is common if the cysts interfere with daily activities or cause a lot of pain. To aspirate the cyst, the area is first numbed with a topical anesthetic. [seton.net]

• Cyanosis

  Vascular compression may cause coolness or cyanosis of areas distal to the cyst. The size of the cyst may vary over time and can increase after activity. [visualdx.com]

• Lacrimation

  In the SPG, these autonomic nerves supply the lacrimal glands (which produces tears) and the inner lining of the nose and sinuses (which produces nasal discharge or congestion). The SPG is located just behind the bony structures of the nose. [americanmigrainefoundation.org]

• Erythema

  There was no warmth, erythema, interval growth, or fluctuance of the mass. She also did not have any systemic symptoms including fever, chills, or recent weight loss. [ped-rheum.biomedcentral.com]

  There is no associated warmth or erythema and the cyst readily transilluminates. [ncbi.nlm.nih.gov]

• Gouty Tophus

  Gouty tophus – A hard, nodular mass commonly found around the fingers, at the tips of the elbows, and around the big toe. Osteosarcoma – Immobile and not well circumscribed. [visualdx.com]

• Arthritis

  They can also be a precursor to or in association with arthritis. Treating ganglion cysts Your doctor may recommend that you just wait and watch your ganglion cyst because it may disappear on its own. [wakemed.org]

  If you found this article helpful, you may also be interested in Arthritis of the Wrist Arthritis of the Wrist (topic.cfm?topic=A00218). Last reviewed: March 2013 Peer-Reviewed by: Stuart J. [web.archive.org]

  People with a persisting or recurring ganglion should be evaluated for signs of systemic forms of arthritis, such as rheumatoid arthritis. What is the prognosis of a ganglion? The prognosis of a ganglion is generally excellent. [medicinenet.com]

  Arthritis Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. [fondren.com]

• Joint Effusion

  […] movement/hip pain, joint effusion, ligament/muscle or tendon tear, bursitis Ankle/foot: Heel or ankle pain, tendinopathy, superficial mass, joint effusion, synovitis, Achilles tendinosis, plantar fascitis, fibromatosis, Morton’s neuroma, bursitis, foreign [southtees.nhs.uk]

  Early on, there is a communicating stalk between the ganglion and synovial compartment that accounts for the waxing and waning size of the ganglion according to variation in the size of joint effusion. [healio.com]

  There was no joint effusion and range of movements was terminally restricted and was painless in all directions. X-ray of left knee joint and hematological parameters were both normal. [imjsu.org]

  Magnetic resonance imaging (MRI) of the left knee showed a moderate joint effusion with an approximately 1.5 cm diameter loculation slightly offset laterally which corresponded to the patient’s knee mass (Figure 1 ). [ped-rheum.biomedcentral.com]

• Swelling of Hand

  Ganglion cysts are soft tissue swellings occurring most commonly in the hand or wrist. Apart from swelling, most cysts are asymptomatic. Other symptoms include pain, weakness, or paraesthesia. [hindawi.com]

• Arthralgia

  […] provided by Nevert Adel, Mansoura University: Ketamine; pain; platelet rich plasma; mastectomy; shoulder Additional relevant MeSH terms: Layout table for MeSH terms Breast Neoplasms Shoulder Pain Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Arthralgia [clinicaltrials.gov]

• Withdrawn

  Needle aspiration is a process where some amount of the fluid in the cyst is withdrawn using a sterile needle and sent for examination to the laboratory. [draguskadir.com.au]

  The area around the ganglion cyst is numbed and the cyst is punctured with a needle so that the fluid can be withdrawn. [orthoinfo.aaos.org]

  Most often performed on ganglion cysts on top of the wrist, the cyst is punctured with a needle so that the fluid can be withdrawn. [bmc.org]

  Needle aspiration is a process where some amount of the fluid in the cyst is withdrawn using a sterile needle. An ultrasound imaging can reveal whether the lump is solid or fluid filled (cystic). [ftlauderdaleortho.com]

• Tingling

  If the cyst is attached to a tendon, you might feel weakness in the affected area, or if it compresses a neighbouring nerve, you may experience a tingling sensation, pain and muscle weakness. [draguskadir.com.au]

  Rebecca had experienced tingling in her hand before. This time, the tingling was accompanied by a rather large lump on the top of her wrist. As the pain increased, she decided it was time to see a doctor. [pacificarehab.com]

  If a ganglion cyst presses up against nerves in the wrist, it can cause symptoms that include numbness, tingling, a weakened grip and a reduced range of motion. When there is pain, it is usually an annoying ache rather than unbearable, sharp pain. [my.clevelandclinic.org]

  If a cyst presses on a nerve it can cause pain, muscle weakness and a tingling sensation. Diagnosis Your doctor will diagnose ganglion cyst by performing a physical examination. [coastlineortho.com]

• Irritability

  Aspiration alone often requires just wearing a hand splint to prevent irritation that might lead to regrowth. Surgery using an arthroscope is less invasive than traditional surgery, and has a faster healing time. [seton.net]

  If you can identify an everyday activity that could be irritating the affected area, look for a way to reduce or modify that activity. [drbenkim.com]

  Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst. Aspiration and injection. [foothealthfacts.org]

  They may arise from an injury or from joint or tendon irritation and overuse. Symptoms Ganglion cysts are sometimes painful. [templehealth.org]

• Paresthesia

  We describe the clinical case of a 43-year-old female with complaints in the previous three months of hypesthesia and paresthesia in the anterior portion of the medial half of the dorsum of her left foot that extended into the first interdigital cleft [ncbi.nlm.nih.gov]

  Main clinical symptoms include posterior knee pain, motor weakness and paresthesia. [jbsr.be]

  If the needle meets obstruction or if the patient experiences paresthesias, the needle should be withdrawn and redirected in a more ulnar fashion. [aafp.org]

  […] of the median nerve can occur when a volar radial ganglion arises within the carpal canal. [5] The ulnar nerve may also be compressed within the tunnel of Guyon when the ganglion presents on the ulnar side of the wrist. [7] The patient can experience paresthesias [emedicine.com]

• Numbness of the Hand

  Surgery is mostly chosen when the mass is painful, restricting movement, or causes tingling numbness of the hand. Surgery is a simple arthroscopic or mini-open wide awake excision of the ganglion cyst. [symptoma.com]

  If there is swelling within the tunnel, the nerve can become compressed, resulting in pain, weakness, and/or numbness in the hand and wrist, radiating up the arm. Scleroderma. [arthritis.org]

  If you have thickness or nodules in your hands or fingers, color change in your hands and fingers that is not due to weather, or tingling and numbness in your hands and fingers, you may have a serious condition. [carpaltunnelpros.com]

  The numb arm and hand. Am Fam Physician. 1995;51:103–16. 9. Rettig AC. Wrist problems in the tennis player. Med Sci Sports Exerc. 1994;26:1207–12. 10. Creamer P. [aafp.org]

• Burning Sensation

  The median nerve provides feeling or sensation to the thumb, index finger, long finger, and half of the ring finger. [en.wikipedia.org]

Most of the ganglion cysts are easily diagnosed by a mere physical examination. They are very smooth and pliable to touch, usually 1-2 cm cystic structures that are well attached to the underlying tendon or capsule. There are no signs of inflammation and the swelling can be felt separate from the skin.

Physical examination is usually sufficient to confirm the diagnosis, but sometimes various imaging techniques to determine any underlying or adjacent pathology are carried out. Radiographs [4] are rarely suggested unless indicated, to detect any bony involvement.

Ultrasonography may be done to determine whether the swelling is cystic or solid. It may also be done to check involvement of an artery or blood vessel. Very rarely cystic fluid aspiration is necessary for further confirmation.

Magnetic Resonance Imaging (MRI) is also used nowadays for diagnosis of ganglions especially wrist ganglions. The drawback is that this procedure is very expensive. All the above mentioned imaging techniques are mainly used only for confirmation of the diagnosis.

• Synovial Cyst

  A ganglion cyst, also known as a synovial cyst, is a benign, fluid-filled cyst found in or around a joint. It is quite common and benign, but it can also be painful and disfiguring. When located inside a joint, a ganglion cyst can limit motion. [hss.edu]

  The synovial and ganglion cysts originating from the facet joint have been named under the name of the Juxtafacet cyst by the several researchers. They put forward that the synovial cyst originated from the synovial joint. [ncbi.nlm.nih.gov]

  The differential diagnosis of a palpable lump located over the ACJ includes osteophytes (figure 5-8), synovial cysts, and supra-acromial bursitis. [web.archive.org]

  The fluid inside the cyst is synovial fluid, which has accumulated and cannot flow back to the joint through the narrow stalk the cyst has formed with the joint. Therefore, ganglions tend to grow continuously. [baur-fromberg.de]

Other than the wait and watch policy, ganglions do not require emergency treatment unless they cause severe pain or restrict movement affecting daily routine. Most disappear spontaneously. Depending upon the presentation, various treatments adopted are aspiration or surgery for removal. Aspiration involves removal of the cystic fluid by an incision with the help of a hypodermic needle, mainly ultrasound-guided. Post aspiration the site is injected with a corticosteroid mainly to reduce inflammation and prevent reoccurrence of cystic fluid. The doctor may splint the joint to provide immobilisation. Though splinting does not really help.

Surgery is mostly chosen when the mass is painful, restricting movement, or causes tingling numbness of the hand. Surgery is a simple arthroscopic or mini-open wide awake excision [5] of the ganglion cyst. Arthroscopic surgery is becoming more and more common due to minimal scar formation and faster recovery. Post-surgery doctors may advice physiotherapy or occupational therapy depending on the patient’s needs.

In comparison to aspiration, arthroscopic surgery has lesser reoccurrence and since it is minimally invasive it is more widely adopted. The prognosis of these swellings varies and chances of reappearance of these swellings are high. Normally these harmless tumours go away by themselves or may require a simple surgery. However, since they have a tendency to reappear, no single mode of treatment is enough.

The prognosis is good. It is most often a cosmetic condition and can be easily dealt with surgically.

The exact cause is uncertain. Current theories suggest herniation or out-pouching of the connective tissue through the joint capsule or tendon sheath which mainly occurs due to degeneration of the connective tissue. Excessive stress and movement of joint also tends to cause growth of these harmless tumours. Thus, a defect in the capsule of the joint or tendon sheath allows the distension and bulging. There is a lot of uncertainity regarding the origin of these soft tissue tumors [1].

The incidence is high in women; the cysts are three times more common in women than men between twenty to forty years of age and very rarely affect children below ten years of age. Most of the tumours of the hand are benign [2] with 60% being ganglion cysts.

The common sites of the ganglion cysts are joints of the wrists and fingers, especially the dorsal aspect of the wrist along the extensor carpi radialis. This accounts for 80% of all the cysts. They also affect the knee joints around the cruciate ligaments and the shoulder joints typically around the acromioclavicular joint.

Occasionally, minute ganglia occur on the flexor aspect of the fingers which although very small are very painful. Depending on the location and attachment, if the cyst occurs overlying soft tissue and bone, they are known as interosseous ganglion cysts. Very rarely, if attached to a muscle, mainly in the gastrocnemius muscle, it is known as intramuscular ganglion cyst.

Histologically, these cysts have multiple lobules separated by septae. Due to absence of epithelial lining, these are not true cysts. The cystic fluid is mainly made up of mucopolysacchrides, mainly consisting of hyaluronic acid and smaller amounts of albumen and globulin. The septae are made of loosely arranged layers of collagen fibres and fibrocytes. These cysts are connected to the joint by a pedicle or a stalk which has a tortuous lumen. The communication between the cyst and the joint is through this stalk which is one way, demonstrated by a contrast dye which travels from the joint to the cyst but not the other way, thus forming a one way valve mechanism [3]. This mechanism is facilitated by micro cysts present in the tissue around the pedicle.

Since there is no known cause for ganglion cysts, there is no method of prevention. Early detection and treatment are recommended.

Ganglion cysts are localised, tense cystic swellings, which usually occur along the joints and tendons of the appendicular skeleton. They contain a gelatinous jelly-like fluid microscopically similar to the synovial fluid; hence are also known as a synovial cyst.

They are benign and generally self limiting and tend to appear and disappear as well as change in size very rapidly. These cysts are smooth to touch and usually attached to the tendon sheath or capsule of the joint.

Ganglion cysts are harmless, non-cancerous swellings which usually occur on the joints of the hands and feet, especially on the back of the wrist. They are small, smooth, bump-like structures which usually appear attached to the tendons below.

They are painless and usually do not require any treatment unless they cause pain or restrict movement. It’s not fully understood how it occurs. The ganglion cysts tends to occur more in women than men. They never spread to other parts of the body. Although they tend to persist most often, they may intermittently appear and disappear. The cysts can be left alone if not symptomatic but if they are larger than 5 cm a surgical excision is advised.

If the cyst causes pain, it is best to seek medical care, the medical health provider will be the best to judge whether the ganglion cyst is a cause of concern or whether no treatment is needed at all.

Generally no tests are required; the doctor diagnoses it by a simple clinical physical examination. The most common treatment used which is patient friendly is a simple surgery for complete removal of the lump. This results in lesser chances of the cysts reappearing. Aspiration of the cystic fluid with the help of a needle is also done, but then the cyst tends to reoccur.
Home care treatment in the form of poultices, plasters and heat is not at all advised as it may aggravate the condition.

1. Colman MW, Lozano-Calderon S, Raskin KA, Hornicek Fj et al. Non- neoplastic soft tissue masses that mimic sarcoma. Orthop Clin North Am. 2014 Apr;45(2):245-55.
2. Darowish M, Sharma J. Evaluation and Treatment of Chronic Hand Conditions. Med Clin North Am. 98:4 2014 Jul pg 801-815
3. Craig A Camasta. Excision of the ganglion cyst. The Podiatry Institute. 1993.
4. Cooper Grant. (2006) Pocket Guide to Musculoskeletal Diagnosis. Springer. P63.
5. Bismil MSK ,Bismil QMK. The wide awake approach to hand and wrist ganglia. OA Case Reports. 2013 Nov 15;2(13):129.