Patient information · Orthopaedics and minor surgery
Ganglion cyst
harmless, and often best left alone
A ganglion is a fluid-filled swelling arising from a joint capsule or tendon sheath, most often on the wrist. It is not a tumour, it does not become cancerous, and roughly half disappear on their own without any treatment. The decision to treat is about symptoms, not appearance.
Arrange assessment rather than assuming a ganglion if the lump is
- hard, fixed or irregular rather than smooth and rubbery
- growing quickly, or larger than about 5cm
- causing numbness, tingling or weakness in the hand
- red, hot and painful, with fever
- pulsating, which may indicate a vascular swelling
- on the palm side of the wrist — these sit close to the artery and need careful assessment
Most lumps around the wrist are ganglia, but not all. A lump that does not transilluminate, is fixed to deeper tissue, or is causing nerve symptoms warrants an ultrasound before anything is done to it.
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.
Do not hit it with a book
The traditional remedy of striking a ganglion with a heavy book — it was once called a Bible cyst — does sometimes burst it. It also risks fracturing the bones underneath, damaging tendons, and causing bleeding into the tissues, and the ganglion usually returns anyway. Please do not do this, and do not let anyone else do it to you.
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.
Why come to us. Most people with a ganglion want to know what it is and that it is not sinister — and that is a single appointment here. We assess the lump, perform ultrasound on site the same visit where the diagnosis is not obvious, and can aspirate it in clinic under local anaesthetic if you want it dealt with. Where surgery is the better option our orthopaedic and hand team can arrange it without a wait. Seven days a week, no referral, published fees.
Diagnosed and treated in one visit
Ultrasound on site, aspiration in clinic. Seven days a week, published fees.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.