Ganglion cyst

What is a Ganglion Cyst?

A ganglion cyst is a fluid-filled swelling that occurs near a joint or tendon. They are most common on the hands, fingers and wrists, but can also be found around other joints such as the foot, knee, or ankle.

Ganglion cysts typically range in size from the size of a pea to the size of a golf ball but may get bigger or smaller. They are filled with a jelly-like fluid called synovial fluid, which is the fluid that lubricates and cushions your joints.

Small ganglion cysts, known as occult cysts, do not cause visible swelling, and you may not be aware that you have one unless they cause symptoms, for example pain or tingling.

Ganglion cysts are not usually harmful and may go away without treatment, though this can take up to two years.

Some ganglion cysts are painful and may cause difficulty with movement especially if they are large. If your cyst is causing symptoms you may need a procedure to drain or remove the cyst.

This page explains what a ganglion cyst is, when it may need treatment, and what treatment options are available.

What causes a Ganglion cyst?

Ganglion cysts happen when synovial fluid leaks out of a nearby joint or tendon causing the tissue to bulge out. The exact cause of ganglion cysts is unknown, but they may be caused by trauma or underlying arthritis.

You are more likely to develop a ganglion cyst if you are:

• Aged 20 to 40
• Female
• Have osteoarthritis
• Have had a previous injury to a joint or tendon

Small ganglion cysts called mucous cysts can develop on the fingers. These are more common in women aged between 40 and 70 and are linked to arthritis of the finger.

Common Symptoms of a Ganglion Cyst?

Symptoms of a ganglion cyst may include:

• A smooth lump under the skin
• Swelling that may come on suddenly or get worse over time
• Your cyst may get smaller, disappear, and then come back
• Pain that may get worse when you move the affected joint
• Restricted movement in the affected joint
• If the cyst is attached to a tendon, you may experience weakness in the affected finger

Do I need ganglion surgery?

If your ganglion is not bothering you, it may be best to leave it alone. About 50% of ganglion cysts disappear without treatment, but this can take between 12 and 18 months.

You should consider treatment if your ganglion cyst:

• Is painful
• Limits your movement, making it difficult to carry out day-to-day tasks
• If the appearance of your ganglion cyst bothers you or makes you feel self-conscious

What to expect at your first consultation

At your first consultation, your consultant will ask you some questions about your general health and symptoms including:

• How long you have had your ganglion for
• Whether or not it's painful
• Whether it restricts your movement
• Whether it changes in size

Your consultant will then examine your ganglion cyst which may include:

• Applying firm pressure to the lump to see if it is painful or tender
• Shining a light on the cyst to see if it is filled with fluid or is a solid lump

How is a diagnosis made?

Ganglions are normally diagnosed by assessing your symptoms and performing a physical examination. In some cases, your consultant may order further tests to confirm your diagnosis including:

• Needle aspiration: your consultant may use a fine needle and syringe to draw out and examine the fluid
• Ultrasound: this can determine whether the lump is solid, or fluid-filled
• Magnetic resonance imaging (MRI scan): this may be used to diagnose an occult ganglion that isn't visible or can't be felt during physical examination

What are the treatments for a Ganglion Cyst?

After your consultant has examined your ganglion and received the results of any test, they will discuss possible treatment options with you.

Treatments for ganglion cysts include:

Leaving the ganglion alone

If your ganglion is not impacting your life either by causing you pain or limiting your movement, it may be best to leave it alone and monitor your cyst to see if it gets better or worse. This is known as watchful waiting.

Immobilisation

Moving the affected area can cause your ganglion to get bigger and may increase pressure on the nerves causing pain. Immobilising the area in a brace or splint can help relieve pain and reduce the size of your ganglion. Your consultant may also prescribe exercises to strengthen the joint and increase your range of motion.

Draining fluid from the ganglion (aspiration)

Draining the fluid from the cyst relieves pain and pressure on the affected joint or tendon and allows you to move the joint more easily. This is normally the first treatment for ganglion cysts as it is less invasive than surgery. One of the downsides of this treatment is that in around half of all cases the cyst can come back as the root of the ganglion has not been removed. If this occurs, surgery may be an option.

Surgery to remove the cyst

This may be recommended if you have severe pain and reduced movement and other methods like aspiration haven't worked.

Your consultant will explain all of the treatment options to you and answer any questions you may have. They will recommend the most suitable option for you based on your symptoms, general health, and personal circumstances.

What are the benefits of Ganglion Cyst removal?

If your ganglion is painful or is restricting your movement, ganglion removal surgery is effective at eliminating these symptoms. Ganglion removal surgery also makes it less likely that your ganglion will come back.

What are the benefits of Ganglion Cyst removal?

Your consultant will tell you everything you need to do to prepare for your surgery. Tell your surgeon about any long-term health problems, or allergies you have, and any regular medications you are taking.Your consultant may tell you to stop taking some medications such as blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs) before your operation. This is to reduce the risk of bleeding during your procedure.

If you are having a general anaesthetic, you will not be able to eat or drink anything from midnight on the day of your surgery.

After your surgery, you may have some pain or discomfort and your wrist may be in a sling for a few days. Try to arrange for someone to check in on you or help with tasks like cooking and cleaning during this time.

What happens during Ganglion Cyst removal?

There are two types of surgery to remove a ganglion cyst.

Open surgery

Open surgery is where the cyst is removed through incisions in the skin.

Arthroscopic (keyhole) surgery

This is where instruments and a camera are inserted through tiny incisions to remove the cyst.

Surgery to remove a ganglion cyst is a minor procedure that typically takes around fifteen to thirty minutes. It is usually performed under local anaesthetic which will numb the area and stop you from feeling any pain.

The surgeon will make a small incision (cut) or incisions at the site of the cyst. The cyst is separated from the surrounding tendons, nerves, and blood vessels and from where it attaches to the joint. The cyst is removed, and the wound is sutured or glued closed. A sterile dressing is applied to the wound.

The exact details of ganglion surgery are different for everyone, and your surgery depends on a variety of factors such as your general health, symptoms, and preference. Talk to your consultant about what to expect during your operation.

Recovering from Ganglion Cyst removal

After your ganglion removal surgery, you can normally go home the same day. You will be given painkillers to help with any post-operative pain.If your surgery was on your wrist, your arm will be put in a sling for a few days to protect it and help to reduce swelling. You may need to have physiotherapy and be given exercises to strengthen your muscles after surgery.

You will not be able to drive yourself home after your surgery, so ask someone to collect you, or we can arrange a taxi if you prefer. You can drive when you feel safe to do so.

If you have a manual job that involves lifting or driving, you may need to take some time off work. Ask your consultant about when you can expect to return to work after surgery.

When will I be back to normal?

Everyone recovers differently from surgery. How quickly you recover depends on several factors including your general health, the type of surgery you had, and whether there were any complications during your surgery.

It's important to follow your surgeon's instructions after your surgery and allow yourself to recover at your own pace. Trying to do things before you are ready may cause further problems and delay your recovery.

It normally takes between two and six weeks to recover fully from ganglion cyst removal surgery. Your consultant will be able to give you a more personalised timeline for recovery based on your individual circumstances.

Potential risks and complications of Ganglion Cyst removal

All surgery carries a risk of complications. Before your surgery, your consultant will perform a complete physical examination and perform some pre-operative tests to reduce the risks as much as possible.You can also reduce your risk of complications by being as healthy as possible before your surgery. These include:

• Stopping smoking
• Sticking to safe limits when drinking alcohol
• Eating a balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• Losing weight if you need to
• Having a positive mental attitude

Some general risks of surgery may include:

• Shock
• Blood loss
• Infection
• Blood clots
• Chest problems
• Problems passing urine (urinary retention)
• Allergic reaction to anaesthesia

Ganglion cyst removal is a minor procedure, so risks and complications are rare, and not usually serious.

Some possible risks and complications of ganglion cyst removal surgery include:

• Pain and stiffness that may be permanent
• Loss of grip strength
• If you have a general anaesthetic, there is a small risk of problems with your heart or lungs
• Infection at the surgery site
• Development of an abnormal mass of nerves called a neuroma
• A thick red scar that may remain numb after surgery
• Damage to the nerves or arteries 
• The cyst may come back after surgery, though this is less common than after fluid aspiration

Your consultant will discuss all the possible risks and complications before your surgery.  Use this time to ask any questions or discuss any concerns you may have. The better informed you are, the more comfortable you will feel and the easier it will be to make an informed decision.