Ganglion Cyst

This leaflet provides general information to help you understand ganglion cysts and the available treatment options.

Not everyone with a ganglion needs surgery.

At the heart of my practice is Shared Decision-Making. Whether we pursue conservative management (Plan A) or surgical intervention (Plan B), the goal is to create a tailored treatment plan that aligns with your lifestyle, values, and functional goals.

The Anatomy of a Ganglion

A ganglion is a fluid-filled lump that arises from a joint or tendon, relying on several structures working together.

How a Ganglion Forms

Think of it as a small balloon of fluid:

• Fluid leaks from a joint or tendon sheath
• It collects in a small sac under the skin
• A stalk connects the sac to the joint

The Fluid

The sac contains a thick, jelly-like fluid, similar to the natural lubricant found inside your joints — it is not cancerous.

Where They Appear

Ganglions form near joints and tendons:

• Back of the wrist (the most common)
• Palm side of the wrist
• Base of a finger, on the tendon sheath
• Often changing in size over time

Good to Know

• They are non-cancerous and harmless
• About half disappear on their own
• They often change in size or come and go
• Pain occurs only if a nerve is pressed

The Result

Most cause only a visible lump, but larger cysts can make it uncomfortable to bend the wrist or grip, and some press on a nearby nerve.

What Is a Ganglion?

A ganglion is a non-cancerous, fluid-filled lump that commonly appears near joints or tendons, most often on the back of the wrist. It is like a small balloon of thick, jelly-like fluid, and it often changes in size — sometimes disappearing on its own.

Types of Ganglion

They vary by where they form:

• Dorsal wrist — the most common, on the back
• Palmar wrist — on the palm side, near the artery
• Flexor sheath — a pea-sized lump at a finger base

Who Gets Them

The exact cause is unknown, but they are:

• Most common between ages 15 and 40
• More frequent in women
• Common with repeated wrist stress
• Seen in gymnasts and manual workers

Symptoms & Examination

Symptoms

• A visible, usually firm and rounded lump
• Some stay hidden under the skin but still ache
• Pain or tingling only if a nerve is pressed

Examination

• The lump is felt and its size noted
• It often transilluminates (glows with light)
• Nearby nerves and pulse checked

Diagnosis

• Usually a clinical diagnosis from examination
• Ultrasound or MRI occasionally to confirm

Treatment Options: A Shared Decision

I will discuss all available treatment options with you, explaining the benefits and risks of each. Your preferences, values, and lifestyle will be considered as we work together to create a treatment plan best suited to your needs — this shared decision-making process ensures you are fully informed and involved in your care.

Treatment Depends On

• Whether the cyst is painful or growing
• Whether it presses on a nerve or artery
• How much it limits grip or wrist movement
• Your preferences and goals

Ganglions are harmless and about half disappear on their own within two years — if it isn't causing trouble, doing nothing is always an option.

Plan A — Non-Surgical

• Observation: often the best choice, as many settle on their own
• Reassurance: they are not cancerous and will not become so
• Aspiration: draining the fluid, though it often returns
• Suturing: a newer technique used with good success

Plan B — Surgical

Considered when…

• Painful: the cyst is very sore or tender
• Large: it limits grip or wrist movement
• Nerve Pressure: it presses on a nearby nerve
• Recurrence: it keeps coming back after draining
• Approach: open or keyhole day-case removal
• The Procedure: known as Ganglion Excision, the cyst and its stalk are removed to reduce the chance of return, usually under anaesthetic. A separate leaflet will be provided for the surgery.

Management Pathway

Questions You May Wish to Ask

• What treatments should I try first?
• How long should I try them for?
• What improvement can I expect?
• What happens if I don't have surgery?