Ganglion Cyst

The vast majority of ganglion cysts arise as small painless bumps ranging in size from 1 to 3 cm. Most have a firm or rubbery consistency and are mobile. Occasionally these cysts can be symptomatic. The most common presenting symptoms include:

• Pain: Typically the pain is dull and persistent and worse at the extremes of wrist motion. More frequently, pain is associated with dorsal ganglion and smaller ganglion size.
• Weakness: Sometimes a ganglion puts pressure on the nerves that pass near the joint; this may weaken hand strength, affect joint motion, or cause tingling in the fingers, hand, or forearm.

Appearance and location is often sufficient to diagnose a ganglion cyst. In addition, the cyst will trans-illuminate with a flashlight on physical exam. Your doctor may remove the cyst fluid to confirm the diagnosis. X-rays are often reserved for cases in which there is suspicion for other etiologies such as osteoarthritis, bone spurs, bone tumors, or fractures. However, x-rays can also be used to determine cyst related damage to wrist bones.

You must take into consideration that most ganglion cysts will disappear without any treatment and often return despite treatment. If the cyst is not painful or interfering with function, often all that is needed is education, reassurance, and expectant management. More aggressive treatment is indicated if a ganglion becomes symptomatic, infected, or is affecting adjacent bones or ligaments. Treatment options include:

• Aspiration: A large, 16 gauge needle is used to aspirate the cyst. This is rarely a permanent solution. In one study with 34 patients, 59 percent of cysts reoccurred within three months.
• Aspiration with a Steroid Injection: This is the most commonly used approach. Thought to be more effective than aspiration alone. However, studies have shown cure rates ranging from 57-79 percent.