Ganglion cyst

A ganglion cyst is a fluid-filled swelling. It's the most common type of swelling you can get in the hand and wrist.

It usually develops near a joint or tendon. The cyst can range from the size of a pea to the size of a golf ball.

Symptoms of a ganglion cyst

A ganglion cyst looks and feels like a smooth lump under the skin. They can happen near any joint in the body.

The cyst is made up of a thick clear fluid called synovial fluid. This surrounds joints and tendons to cushion them during movement.

Ganglions are harmless. They can be painful, but this is not common.

You can usually leave them alone. They may disappear without treatment, but this can take years.

It's not clear why ganglions form. They seem to happen when the synovial fluid leaks out of a joint or tendon and collects in a sac. In some cases, there is a history of injury or the joint is developing arthritis.

Diagnosing a ganglion cyst

A GP can usually tell if you have a ganglion cyst. If they are unsure, they may send you for some scans.

Treatment for a ganglion cyst

You do not always need treatment for a ganglion cyst. But sometimes treatment is recommended if the cyst causes pain or affects the movement in a joint.

The 2 main treatment options for a ganglion cyst are:

• draining fluid out of the cyst with a needle and syringe (aspiration)
• surgical removal of the cyst

Aspiration

Aspiration drains fluid out of the cyst. It is usually carried out in the outpatient department of your local hospital or GP surgery.

Your doctor will use a needle and syringe to remove as much of the fluid of the ganglion as possible.

The area is sometimes also injected with steroid medicine to help stop the ganglion from returning.

It is thought that this reduces the risk of the cyst coming back. But there is no clear evidence that it does.

After the procedure, a plaster is placed over the small hole in your skin. This can be removed after around 6 hours.

Aspiration is often the first treatment option offered for ganglion cysts as it's less invasive than surgery. It's simple and painless. You'll be able to go home straight after.

Around 1 in 2 ganglion cysts come back after aspiration. If your cyst comes back, you may need surgery.

Surgery

Surgery to remove a ganglion cyst is usually done under either:

• local anaesthetic - where you're awake but do not feel any pain
• general anaesthetic - where you're asleep during the operation

Your surgeon will guide you on which is best for you.

The surgeon will make a cut over the site of the affected joint or tendon.

Sometimes, you may be offered keyhole surgery instead. This is where a small camera is placed inside the joint. The surgeon will then pass instruments attached to the camera inside to remove the ganglion.

After the operation

You will have a wound, covered with a bandage. The bandage helps keep it clean and reduce the risk of infection. It can also protect it from any accidental bumps.

The wound is not usually painful. But you can get painkillers if you have pain or discomfort after the operation.

If the cyst was removed from your wrist or hand, you may need to wear a sling for the first few days.

This helps keep your arm safe from any accidental knocks. It may also help reduce swelling and discomfort. Move your fingers regularly to help keep the joints flexible.

Scar, bruising and stiffness

Surgery to remove a ganglion cyst leaves a scar, which can occasionally be thick and red. For some people, the skin around the scar remains numb after the operation.

You'll usually have some bruising in the area after your operation. This should fade quickly.

You may have some stiffness, swelling or pain afterwards. This may be caused by a minor infection. Your doctor may prescribe antibiotics.

If you have lasting pain or stiffness, you may need physiotherapy.

Taking time off work

How much time you need to take off work after surgery depends on the type of work and recovery. Many people return to work within a few days or a few weeks.

If your job involves manual labour, you may need more time to recover than someone with a desk job.

Most people can drive again when they feel confident.

Complications

Having a ganglion cyst removed is a minor procedure. Complications are rare and usually not serious. You can have permanent stiffness and pain after surgery. But this does not happen often.

Complications can happen during or after a general anaesthetic, but these are rare. Your doctor will explain the risks to you before the procedure.

They will check for any complications afterwards and give you treatment if you need it.

Tests before surgery should make sure your risks are as low as possible.

There's always a chance a ganglion cyst will come back after treatment. This is more likely if the ganglion is on certain areas of the wrist, especially the palm-facing side of your wrist