Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons. The most common locations are the top of the wrist (see Figure 1), the palm side of the wrist, the base of the finger on the palm side, and the top of the end joint of the finger (see Figure 2). The ganglion cyst often resembles a water balloon on a stalk (see Figure 3), and is filled with clear fluid or gel. They can also occur on the foot and ankle adjacent to joints or tendons of the foot and ankle.
The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages.
These cysts may change in size or even disappear completely, and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.
The diagnosis is usually based on the location of the lump and its appearance. Ganglion cysts are usually oval or round and may be soft or firm. Cysts at the base of the finger on the palm side are typically very firm, pea-sized nodules that are tender to applied pressure, such as when gripping. Light will often pass through these lumps (trans- illumination), and this can assist in the diagnosis. Your physician may request x-rays in order to look for evidence of problems in adjacent joints. Cysts at the far joint of the finger frequently have an arthritic bone spur—which is a small bony bump or projection—associated with them, the overlying skin may become thin, and there may be a lengthwise groove in the fingernail just beyond the cyst.
Ultrasound or other advanced imaging such as magnetic resonance imaging (MRI) may be helpful in confirming the diagnosis. There are different types of growths that can occur around the and wrist, and additional imaging is sometimes required.
Treatment can often be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless, as they frequently disappear spontaneously. If the cyst becomes painful, limits activity, or is otherwise unacceptable, several treatment options are available.
An aspiration can be performed to remove the fluid from the cyst and decompress it. This requires placing a needle into the cyst, which can be performed in most office settings. Aspiration is a very simple procedure, but recurrence of the cyst is common. If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available.
Surgery involves removing the ganglion cyst along with a portion of the joint capsule or tendon sheath (see Figure 3). In the case of wrist ganglion cysts, both traditional open and arthroscopic techniques usually yield good results. Surgical treatment is generally successful although cysts may recur. Your surgeon will discuss the best treatment options for you.
The board certified surgeons at Specialty Surgeons of Palm Beach perform non-surgical and surgical treatment for ganglion cysts and other hand, wrist, foot, and ankle conditions. Doctor Michael Lake, MD, is a double board certified General Surgeon and Plastic Surgeon with extensive training in reconstructive hand surgery from the University of Miami, FL. He treats patients for ganglion cysts and other hand conditions in Jupiter, Palm Beach Gardens, and West Palm Beach, Florida. Doctor Lake performs ganglion cyst surgery in Palm Beach Gardens and Hollywood, Florida.