Ganglion Cyst (A Cyst in the Wrist)

A ganglion cyst is a benign swelling arising from a joint capsule or tendon sheath and filled with a gel-like fluid resembling egg white. It is not cancer and does not become cancer. It most commonly occurs on the back of the wrist, followed by the palm side, and may also appear at the base of a finger or over its end joint.

The cyst develops when joint fluid escapes through a weak point in the capsule and forms a sac. A narrow stalk connects the sac to the joint. This explains why the cyst may enlarge with hand use, shrink with rest and return after simply being burst.

Ganglion cysts can occur at any age and are slightly more common in young adults and women. Most develop without an obvious injury. A mucous cyst over the end joint of a finger often occurs with osteoarthritis in that joint; treatment planning then depends on the condition of the joint. Osteoarthritis of the hand and finger joints is covered separately on the hand surgery overview page.

Most ganglion cysts are painless and the patient is concerned only about appearance. Typical findings in symptomatic cysts include:

• A round, well-defined swelling moving beneath the skin on the back or palm side of the wrist
• Swelling increases with hand use and decreases at rest, sometimes disappearing spontaneously and returning
• Dull pain increases when bending the wrist backwards, such as in press-ups or pushing off the floor
• Reduced grip strength and a feeling of restricted wrist movement
• Hand or finger numbness and tingling if the cyst presses on a nerve
• Point tenderness when gripping objects with small, firm cysts at the finger base

Diagnosis is usually made by examination. The cyst's location, consistency, relationship to skin and deeper tissues, and whether it changes with wrist movement are assessed. Passing light through a fluid-filled cyst from behind the swelling (transillumination) is a simple examination technique that supports diagnosis.

Ultrasound is frequently used to determine whether a swelling contains fluid or solid tissue and assess nearby vessels and nerves. X-rays are taken if associated osteoarthritis or bone changes are suspected. MRI is occasionally requested for an unusual location or atypical examination findings.

Not every growing hand swelling is a ganglion cyst. Hard, progressively enlarging masses that adhere to skin or cause night pain need detailed assessment; their management is explained on the bone and soft tissue tumours page.

Many ganglion cysts cause no pain and may shrink or disappear spontaneously. Observation is therefore the first choice for symptom-free cysts: their benign nature is explained and changes in size or symptoms are monitored.

If there is pain, restricted movement or difficulty using the hand, three options are discussed. The first is short-term use of a wrist support and reducing strenuous movements; the cyst may shrink, but the duration is limited because prolonged immobilisation can weaken the wrist. The second is needle drainage (aspiration): the contents are withdrawn and medication may be administered in the same session. It is straightforward and may provide rapid relief, but recurrence is common because the connection to the joint remains.

Striking a cyst with a book to burst it is not recommended; it may damage nearby tendons, nerves and blood vessels, and the cyst usually returns.

Surgery is considered for persistent pain, repeated recurrence, restricted wrist movement or nerve compression causing numbness. Requests for removal because of appearance are also assessed, but scarring and recovery are discussed before deciding.

During surgery, the cyst is not simply drained: its sac and the stalk extending to the joint capsule are removed. This is the key step in reducing recurrence. The procedure may be performed through open surgery or, in suitable cases, arthroscopically; regional anaesthesia is usually sufficient, and patients generally return home the same day. Cysts on the palm side of the wrist require particularly careful planning because of the nearby artery.

Ganglion cysts may recur in some patients even after surgery; this possibility is explained beforehand. No outcome is promised, and expectations are discussed realistically.

Ganglion cysts also occur in the foot and ankle, although less frequently. They are most common on the top of the foot, around the ankle and over toe joints. Shoe pressure is the main cause of symptoms: a cyst beneath laces or the shoe upper may cause pain, redness and discomfort when walking.

Assessment and treatment follow the same principles as in the hand: painless cysts are monitored, footwear and padding are adjusted to reduce pressure, and persistent symptoms may prompt discussion of drainage or surgical removal together with the stalk. For other problems, see foot and ankle conditions.

After surgery, the wrist is supported briefly with a bandage or splint. Finger movement starts on the first day, while wrist movement begins within a few days according to the wound. Prolonged immobilisation may cause wrist stiffness.

Keep the hand dry until the wound heals; stitches are usually removed within two weeks. Pain and swelling settle in the early weeks, but incision tenderness may last months. Desk work is often possible fairly soon; return to forceful manual work takes longer and is determined at follow-up.

Avoiding movements that force the wrist backwards, such as pushing yourself up from the floor, press-ups and heavy pushing, can help while the cyst is painful. A cyst naturally shrinking and enlarging is expected and is not, by itself, a cause for concern.

Do not delay assessment if swelling grows rapidly, hardens, causes night pain or is accompanied by hand numbness. Book by telephone or WhatsApp at AC CLINIC in Altınordu, Ordu.