Ganglion cysts are the most common soft tissue tumors of the hand. Ganglion cysts are benign growths but can cause pain and compression syndromes. They typically arise from a joint or the sheath of a flexor or extensor tendon. The cyst itself contains a clear mucinous type material that looks like a clear gel. The cyst itself can be translucent therefore in the dark when light is applied to it. The cyst is usually attached to a stalk from its origin. It is important to identify the stalk if possible and resect it together with the cyst and all the cystic materials. Ganglion cyst stalks typically originate from deep bony joints.
Ganglion cyst most common locations are the dorsal aspect of the wrist joint. About 70-80% of ganglion cysts occur there. The most common location of a dorsal ganglion cyst is over the scapho-lunate ligament. The other most common location of ganglion cyst in the hand is the volar wrist typically over the scaphoid tubercle.
Ganglion cysts can occur anywhere on the wrists, hand, and digits.
Ganglion cyst treatment varies depending on the symptoms. Most ganglion cysts can be asymptomatic. They can enlarge over time but they can also regress over time. Therefore I offer the option to my patients to observe them once I have made the diagnosis. Some patients may elect to have their ganglion cysts removed surgically because they may not be aesthetically pleasing.
Ganglion cysts are most likely to cause painful and compression symptoms once they enlarge. Among these symptoms can be compression of the median and ulnar nerves in the wrist, which would be associated with numbness, and tingling of the fingers.
It is best to proceed with surgery at that point.
A popular myth about ganglion cysts is that they can be treated by “popping” them with a needle or by intense pressure. In general popping a ganglion cyst with a needle can deflate it but the cyst will refill over time because the ganglion cyst wall is not removed and the ganglion cyst stalk is also not removed.
Ganglion cyst effective therapy therefore consists or operative resection of the cystic lining, the cystic materials and the stalk. Surgery is performed through very small incisions over the wrist that heal well with proper plastic surgery technique and delicate tissue handling. Sutures are removed after 10-14 days. Patient can return to work within a few days from surgery depending on the work.
Ganglion cysts can reoccur despite surgery particularly if the stalk remains or part of the cystic lining remains. That is part of the surgery should include thorough exploration of these structures.