Private ganglion cyst clinic in London, same-day physiotherapy.

What they are

• A smooth, rubbery or firm swelling, often varying in size over weeks and sometimes disappearing and returning.
• Commonest on the back of the wrist, then the palm side, the base of a finger, and the top of the foot.
• Often painless. When they do ache, it is usually a dull ache worse with activity or at the extremes of movement.
• A ganglion at the end joint of a finger — a mucous cyst — is associated with arthritis in that joint and can groove the nail.
• They shine when a light is held against them, which helps distinguish them from solid lumps.

Doing nothing

This is a legitimate and often the best option. Around half of wrist ganglia resolve spontaneously within a few years, and there is no harm in waiting where the lump is painless and not restricting you. Reassurance about what it is turns out to be the only treatment many people actually want.

Aspiration

• The fluid — thick and jelly-like — is drawn off with a needle under local anaesthetic. Quick, done in clinic.
• Recurrence is common, around half or more, because the stalk connecting it to the joint remains.
• It is reasonable where you want the lump gone quickly, or want the diagnosis confirmed.
• Ultrasound guidance improves accuracy and is used for deeper or awkwardly placed ganglia.
• Aspiration is generally avoided on the palm side of the wrist, because the radial artery runs alongside.

Surgery

• Excision removes the cyst and its stalk, which is why recurrence is much lower — around one in twenty.
• Performed under local or regional anaesthetic as a day case.
• Leaves a scar, and the wrist is often stiff for several weeks; hand therapy helps.
• Small risks include nerve irritation, scar tenderness and reduced wrist movement.
• Usually reserved for ganglia that are painful, restricting function, pressing on a nerve, or have recurred after aspiration.