Ganglion Cysts

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Ganglion cysts are non-cancerous lumps that commonly arise from the tendons or joints of the wrist, hand, or fingers. They can also occur on the ankles or feet, although less frequently. These cysts are filled with a thick, clear, jelly-like fluid known as joint fluid, and are often covered by a thick sheath. Ganglion cysts may vary in size, sometimes becoming more prominent with activity and shrinking with rest.

While generally harmless, they can cause discomfort, restrict joint movement, or press on nearby nerves, leading to pain or weakness.

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Ganglion Cysts

Ganglion cysts present with a variety of symptoms depending on their size, location, and whether they press on surrounding structures.

Visible Lump: A round or oval lump is the most common symptom. Ganglion cysts typically develop on the top or palm side of the wrist, at the base of the fingers, or occasionally on the ankles or feet. Depending on their size, they may feel firm or spongy to the touch.
Pain or Discomfort: While most cysts are painless, some cause aching or sharp pain if they press on a nerve.
Reduced Mobility: Cysts near joints or tendons may restrict movement or cause stiffness in the affected area.
Weakness: Compression of nearby nerves by the cyst can lead to weakness or a decrease in grip strength in the affected hand or wrist.
Fluctuating Size: The cyst may change in size, often enlarging with repetitive movements or physical activity and shrinking during periods of rest.

Causes and Risk Factors

While the exact cause of ganglion cysts is unknown, certain factors are thought to increase their risk of developing.

Repetitive Stress: Regular or repetitive movements that place stress on the wrists or hands can make ganglion cyst formation more likely.
Arthritis and Tendon Inflammation: Osteoarthritis or inflammation around tendons may contribute to the development of cysts, especially in joints subjected to frequent use.
Injury: Previous injuries to joints or tendons can weaken the area, potentially leading to cyst formation.
Age and Gender: Ganglion cysts most commonly occur in individuals aged 20 to 40 and are more frequently observed in women than in men.

Diagnosis of Ganglion Cysts

Physical Examination

The lump is assessed for its size, tenderness, and mobility. A light test (transillumination) with a pen torch is commonly used to determine if the cyst is fluid-filled. Applying pressure to the cyst can help identify pain or discomfort.

Imaging Studies

If the diagnosis is uncertain, an ultrasound or MRI may be performed to evaluate the size of the cyst and its relationship to surrounding tissues. These imaging methods can also help exclude other conditions, such as bone abnormalities or vascular issues.

Aspiration or Biopsy

In rare cases, a small amount of fluid may be withdrawn from the cyst (aspiration) for analysis. This process confirms the diagnosis and rules out other possible causes of the swelling, such as infection or tumours.

Treatment Options

Treatment for ganglion cysts depends on the severity of symptoms and the impact on daily activities. Mild cases may require no treatment, while symptomatic or persistent cysts often need intervention.

Non-Surgical Treatment

Observation and Monitoring

Many ganglion cysts resolve naturally over time. If the cyst does not cause pain or interfere with function, monitoring may be sufficient. However, it is necessary to watch for changes in the cyst, such as rapid growth, new pain, or increased discomfort. If these symptoms occur, further evaluation may be needed.

Immobilisation

Wearing a splint or brace can help reduce movement in the affected area, relieving pain and preventing the cyst from enlarging. Immobilisation is particularly helpful for cysts linked to repetitive strain injuries. Prolonged immobilisation, however, should be avoided to prevent joint stiffness.

Aspiration

Fluid can be removed from the cyst using a needle (aspiration), providing temporary relief from pain and reducing the lump’s size. However, recurrence is common because the cyst wall remains intact, and aspiration carries a small risk of infection.

Pain Management

Over-the-counter pain relievers, such as paracetamol or ibuprofen, can help alleviate discomfort caused by the cyst. In cases of significant inflammation, corticosteroid injections may help reduce swelling and pain.

Surgical Treatment

Ganglion Cyst Excision

Surgery involves removing the cyst along with its surrounding membrane and the stalk that connects it to the joint or tendon sheath. This method significantly reduces the risk of recurrence. Recovery typically takes a few weeks and may involve physical therapy to restore strength and mobility.

Arthroscopic Surgery

Minimally invasive arthroscopic techniques may be used in certain cases to remove the cyst. This approach involves smaller incisions, leading to a shorter recovery time. Post-operative therapy may still be needed to ensure optimal joint function and prevent stiffness.

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Prevention and Management

Although ganglion cysts cannot always be prevented, steps can be taken to reduce the risk of their development. Avoiding repetitive stress on the wrists and hands, using proper techniques during physical activities, and wearing supportive braces during high-risk tasks can help minimise strain on joints and tendons. Incorporating ergonomic tools and maintaining proper posture during repetitive tasks can reduce the likelihood of strain-related injuries. For individuals with existing cysts, regular monitoring, avoiding activities that aggravate symptoms, and following a personalised treatment plan can help manage the condition effectively.

Frequently Asked Questions

Are ganglion cysts related to other joint conditions?

Yes, conditions such as arthritis and tendonitis can increase the risk of ganglion cysts. These conditions place additional stress on joints and surrounding tissues, which may contribute to cyst formation.

Can ganglion cysts develop in multiple locations at once?

Yes, although uncommon, ganglion cysts can form on multiple joints simultaneously. This is more likely in individuals with underlying joint-related conditions or widespread tendon stress.

Can ganglion cysts recur after being surgically removed?

Surgical removal significantly lowers the risk of recurrence, but cysts can return if a portion of the stalk remains or if the underlying joint condition causing the cyst is not addressed.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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