Hand and wrist guide
Ganglion cysts are harmless and can often be left alone. This guide explains where they appear, how they are diagnosed, and the options if yours is causing trouble. Those options range from reassurance and waiting, to drawing off the fluid with a needle, to surgery.
Written by Mr Alistair Jepson
Consultant Orthopaedic Surgeon · GMC 4104128
Ganglion cysts are the commonest type of swelling in the hand and wrist. They contain a thick, clear, gel-like fluid, and the lump resembles a water balloon on a stalk. They arise from a variety of structures, including joints and the lining of tendons.
They may fluctuate in size, and some may eventually disappear completely.
A ganglion cyst is not cancerous and will not spread to other areas.
There are four typical locations.
Dorsal wrist ganglion
Arising from one of the extensor tendons, or from the wrist joint, coming through the scapholunate ligament.
Palmar wrist ganglion
Next to where you can feel the pulse, arising from the wrist joint.
Flexor tendon sheath ganglion
Arising from one of the tendon sheaths.
Dorsal digital ganglion
Called a mucous cyst. See also the guide to finger arthritis of the DIP, PIP and MCP joints.
These swellings can be a nuisance.
Wrist pain with tingling can have other causes too, such as carpal tunnel syndrome or a TFCC tear.
Interference with movement
If they become very large, they can interfere with wrist movement.
Aches and pains
They can be associated with aches and pains in the wrist, but these often do not settle just by removing the swelling.
Pressure on a nerve
Occasionally the swelling presses on a nearby nerve, causing pain or altered sensation.
No one really knows why these swellings appear in some people and not others.
Most arise spontaneously, but occasionally there is a history of injury to the wrist, or the nearby joint is starting to develop arthritis.
Some disappear completely on their own.
The diagnosis is usually straightforward, as ganglion cysts tend to be smooth and round, fluctuate in size and occur at characteristic places in the hand and wrist. If the diagnosis is uncertain, scans and X-rays can help.
X-rays may be useful to look for arthritis in a joint near the ganglion, as the arthritis might also need treating to stop the ganglion returning.
In a younger person with symptoms in the wrist, not just around the swelling, investigations to exclude a ligament injury may be useful.
If there is any doubt that the swelling is just a ganglion, an ultrasound or MRI scan may be arranged.
Read more about each scan in the imaging and scans guide.
Ganglion cysts are harmless and can safely be left alone. Many disappear on their own (perhaps up to 50% if watched for several years), many others cause little trouble, and there are no long-term consequences from leaving a ganglion untreated.
The recommendation for any cyst depends on where it is and the symptoms it causes. For example, a ganglion that grows very large may interfere with how the wrist works, and if this persists and is a real nuisance, surgical removal may be considered.
The figures below are general guides, not a prediction for any one person. Mr Jepson will talk through what applies to your ganglion.
"Although my job title is surgeon, my preferred way of treating almost everything I see is without an operation, using injections and rehabilitation. The key thing is to give you, the patient, as clear an explanation of your options as I can, and some guidance on which is the most appropriate for you."
Aspiration avoids an operation and lets you use your hand almost straight away, so if a ganglion needs treating it is often tried before surgery.
Aspiration means drawing off the gel-like fluid with a needle under local anaesthetic. It takes only a few minutes, and you can use your hand normally soon afterwards.
Because the root that connects the cyst to the joint stays in place, a ganglion can return after aspiration; the chance for each type is set out in treatment by type of ganglion. If it returns, it can be drained again, or surgery can be considered.
For a palmar wrist ganglion, the needle is usually guided by ultrasound. The scan shows the cyst on screen while the needle goes in, so it can be placed precisely in the fluid and kept clear of nearby nerves and blood vessels.
It is a brief outpatient procedure under local anaesthetic, and you go home the same day.
Read more about ultrasound-guided procedures in the imaging and scans guide.
The gel-filled sac, which comes from the tendon lining or a nearby joint, is removed.
The lump you see is often the tip of the iceberg. Much of the sac lies beneath the skin, between tendons, blood vessels and nerves, and down into the joint. Fully removing a ganglion is therefore a bigger task than it first seems, and it usually cannot be done under local anaesthetic alone. It is done as a day case, usually under a regional anaesthetic that numbs the whole arm, or a general anaesthetic.
A short clip showing how a ganglion is removed together with its root. It may help you picture the operation before you talk it through with Mr Jepson.
Through a cut, usually 2.5 to 5cm (1 to 2 inches) long, over the affected joint or tendon.
When a mucous cyst is removed, any bony spur on the end finger joint may be removed at the same time.
Smaller cuts are made, and a tiny camera is used to guide the instruments inside the joint. This approach is suitable only for dorsal wrist ganglions.
Deciding together, in your own time.
Agreeing to an operation is a conversation, not just a signature. Mr Jepson talks through what removing your ganglion involves, what it can and cannot achieve, the possible complications listed below, and the alternatives, including aspiration or leaving the lump alone.
The practice uses Concentric, a secure digital consent system. You are sent a link so you can read about your operation at home, share it with family, note down any questions and record your decision when you are ready. Your consent is checked again with you on the day, and you can change your mind at any point.
Read how consent fits into your journey, from pre-assessment to the anaesthetic and going home, in the day of surgery guide.
The wound is closed with stitches and covered with a bandage to keep it clean and protect it from knocks. It is not usually very painful, and you will have painkillers if you need them.
After surgery on the wrist or hand you may have a splint or half plaster to limit movement while it heals, and a sling for the first few days to protect the arm and reduce swelling. Read the aftercare and sling guide.
Move your fingers regularly to keep the joints supple. If pain or stiffness lasts, hand therapy may be needed.
The scar can occasionally be thick and red, and for some people the skin around it stays numb.
This depends on your job and where the ganglion was. Manual work may need longer off.
You can usually drive again once it feels safe to do so. Read the driving guidance.
Removing a ganglion is a minor procedure, so complications are rare and seldom serious.
Short-term bruising is common and fades quickly.
A minor infection can cause temporary stiffness, swelling or pain, and can be treated with antibiotics.
Short-term numbness around the scar is quite common, because the nerves in the hand and wrist are sensitive to stretching. Long-term nerve damage is infrequent.
Temporary stiffness, swelling or pain is possible. Permanent pain and stiffness, including complex regional pain syndrome (CRPS), is rare but can be disabling.
Ganglions around the wrist are more likely to return than those in the finger. See treatment by type of ganglion.
There is a very small risk to the heart and lungs. Pre-assessment tests before surgery help keep risks as low as possible.
Please do not. Hitting a ganglion with a heavy object to burst it is an old remedy that is best avoided: it can injure the hand and the surrounding tissues, and the cyst often returns. A mucous cyst connects to the finger joint underneath, so please do not pierce it yourself either.
There is no fixed date. It depends on the operation you have had, whether you need a splint and for how long, and how quickly movement and grip come back. To drive safely you need to grip and steer without pain or weakness, and to react normally in an emergency so you do not cause injury to yourself or anyone else.
UK rules expect drivers to steer with both hands unless the DVLA has given specific permission otherwise, so your wrist and fingers need enough strength and movement to hold the wheel firmly. You are responsible for being in control of the car at all times, and should be able to show this if you are stopped by the police.
Do not drive while taking strong painkillers that can make you drowsy, such as opioids, or for at least 24 hours after an anaesthetic. You only need to tell the DVLA if problems affecting safe driving are likely to last more than three months after the date of your operation. Check with Mr Jepson, your hand therapist and your motor insurer before you start driving again.
In short
Many insurers ask for a GP referral and an authorisation number before your first appointment, so check with them first. If you are paying for yourself, the practice team can advise on booking. Fees and the insurers Mr Jepson works with are on the home page.
Mr Jepson sees patients in Northampton and Kettering. See where Mr Jepson sees patients.
Other hand and wrist problems that can cause a lump, pain or tingling.
Call to arrange a consultation, book online for Circle Three Shires Hospital in Northampton, or send a short email and the practice team will come back to you.
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