Ganglion cysts

Ganglion cysts are extremely common conditions that occur about the hand and wrist. They can be found on on nearly every part of the hand and wrist. Ganglion cysts are usually painless and people may wait long periods of time before noticing them. They can be large or small usually painless but sometimes they can cause problems.

Ganglion cysts usually originate from a joint. Every  joint is covered with a capsule and connected with ligaments and sometimes because of trauma, or for no reason at all, a small hole in the in the covering of the joint develops and the fluids in the joint starts to escape. This forms a balloon or sack with fluid entering the sack.  Over time the sack  can become thickened  and the fluid within it can become thickened as well. In fact the fluid within the cyst becomes gelatinous jelly like.



Volar ganglion cyst



Ganglion cysts that appear in the back of the wrist are called dorsal ganglionic cysts  and those that occur on the palm side of the wrist they are called volar ganglionic cysts. Cysts can occur within the tendons of the hand and these are called retinacular cysts.  When they appear at the tip of the finger beneath the nail they are called mucous cysts.

Ganglion cysts can usually be diagnosed easily with a history and physical examination. X-rays and MRIs are usually not needed however if there is any question your Dr. will likely order an MRI to rule out any other conditions that may be more serious. Often a simple flashlight test can help diagnose the ganglionic cyst. Since the cyst is filled with fluid placing a light at the base of the mass will cause the ganglionic cyst to illuminate and this is helpful in making the diagnosis.

There are a variety of treatments available for ganglionic cysts but the most important decision is whether to treat it at all.  Reasons for treating ganglionic cyst include cysts that are painful, cysts that are causing damage to structures in the area such as nerves, arteries or tendons, uncertainty about the diagnosis, and cosmesis. Many people have the cyst removed because they don't like it or don't like the way it looks and this is reasonable.

The main treatments available for ganglionic cysts include aspiration or excision. Aspiration of the cyst involves putting a needle in the cyst cavity and removing the fluid. As you can imagine while this removes the fluid it leaves the sack in place which is sometimes absorbed by the body but other times it refills with fluid. A more definitive way to remove the cyst is to take it out surgically. This is often done under local anesthesia with a small incision however in certain places it can be done arthroscopically



MRI showing ganglion cyst (white ball)



The most important take-home message about ganglionic cyst is making the correct diagnosis.  If there is any question that it is not a cyst you should see your doctor.

Dr. Jack Choueka

Adult and Pediatric Upper Extremity Surgeon 

Chairman of Orthopaedic Surgery at Maimonides Medical Center. 

Award winning hand surgeon Dr. Jack Choueka provides treatment for

all disorders of the upper extremity, including carpal tunnel syndrome,

arthritis, trauma, rotator cuff disease, and sports-related shoulder, elbow and wrist problems. He performs state-of-the-art surgery, including shoulder, elbow and wrist replacements. Dr. Choueka is a summa cum laude graduate from State University of New York Health Science Center’s Medical School; he completed his residency in Orthopaedic Surgery at theHospital for Joint Diseases Orthopaedic Institute and his fellowship in upper extremity and microvascular surgery at the University of Chicago

 Dr. Choueka can be reached at 718-283-7400.