Ganglion Cysts

Ganglion cysts are sacs of synovial fluid that originate from the tendon sheaths or joints. They commonly occur in the wrist and fingers but can occur anywhere there is a joint or tendon sheath.

Ganglion cysts are thought to occur when the synovial membrane of the tendon sheath or joint herniates, forming a pouch. Synovial fluid flows from the tendon sheath or joint into the pouch, forming a cyst (a fluid-filled sac). 

 

Presentation

Ganglion cysts can appear rapidly (over days) or gradually. Patients present with a visible and palpable lump. It is not usually painful. Rarely, they may compress nerves, leading to sensory or motor symptoms.

On examination, ganglion cysts:

  • Range in size from 0.5 to 5cm or more (most are 2cm or less)
  • Firm and non-tender on palpation
  • Well-circumscribed
  • Transilluminates (shining a torch into the cyst causes the whole lump to light up)

 

Diagnosis

Ganglion cysts are mostly diagnosed clinically, based on the history and examination findings. 

X-rays will show normal bones and joints (unless there are co-existing conditions). 

Ultrasound can help confirm the diagnosis and exclude other causes of lumps.

 

Management

Ganglion cysts may be managed conservatively, without any intervention. 40-50% of cysts will resolve spontaneously, but this can take several years.

Active management options for ganglion cysts are:

  • Needle aspiration (draining the cyst by aspirating the fluid with a needle)
  • Surgical excision (open or endoscopic removing the cyst, usually under local anaesthetic)

 

Needle aspiration has a high rate of recurrence (50% or more).

Surgical excision involves removing the entire cyst and the affected part of the joint capsule or tendon sheath. Therefore, the recurrence rate is low. However, there is a risk of complications, such as infection and scarring.

 

Last updated August 2021
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