A ganglion cyst is a non-cancerous, fluid-filled lump that commonly develops near joints or along the tendons, most frequently on the wrist or hand. This benign mass forms when joint fluid leaks out of a joint capsule or tendon sheath and collects in a localized sac beneath the skin. While they can spontaneously appear and disappear, many people seek treatment when the lump becomes visually bothersome or causes discomfort. Surgical excision is an effective option for definitive removal.
Initial Approach: Observation and Aspiration
Management of a ganglion cyst begins with the least invasive methods, especially because many cysts resolve without intervention over time. If the lump is painless and does not interfere with function, a healthcare provider will often recommend a period of observation, sometimes called “watchful waiting.” Activities that cause the cyst to increase in size or become painful may be limited, sometimes with the temporary use of a splint or brace.
If the cyst causes pain or limits movement, the next step is typically aspiration. Aspiration is a procedure performed in a clinic setting where the area around the cyst is numbed with a local anesthetic. A sterile needle is then inserted into the cyst to drain the thick, viscous fluid.
While aspiration offers immediate relief, it only removes the contents of the cyst, not the cyst wall or its connection to the joint. Because the stalk connecting the cyst to the joint remains, the recurrence rate after aspiration is high, sometimes affecting around half of treated cysts. Failure to provide long-term relief often leads to a discussion about surgical options.
Criteria for Surgical Removal
A healthcare provider typically recommends surgical removal, known as a ganglionectomy, only when less invasive treatments have failed or when the cyst presents specific complications. The primary indication for surgery is persistent, significant pain or discomfort that limits a person’s ability to perform daily activities. This pain may be particularly noticeable during movement of the affected joint.
Surgery is also considered when the cyst causes functional impairment, such as restricted range of motion. If the cyst grows large enough to press on surrounding nerves, it can cause symptoms like numbness, tingling, or muscle weakness. The failure of multiple aspiration attempts to provide lasting relief is another common reason to proceed with definitive surgical excision.
Surgical Excision Procedure
Surgical excision, or ganglionectomy, is the definitive treatment designed to remove the entire cyst structure, significantly reducing the likelihood of recurrence. The procedure is usually performed on an outpatient basis, meaning the patient typically goes home the same day. Depending on the location and size of the cyst, the surgeon may use general anesthesia, regional anesthesia (a nerve block), or local anesthesia.
The surgeon makes a small incision over the cyst and carefully dissects the mass away from the surrounding tissues, such as tendons and nerves. The primary objective is to trace the cyst back to its origin, often a stalk connected to the joint capsule or tendon sheath. Removing this stalk or root, sometimes with a small piece of the joint capsule, is necessary to minimize the chance of the cyst reforming. The surgeon then closes the incision with sutures, and the area is typically dressed and immobilized in a splint.
Post-Removal Recovery and Recurrence
Following surgical excision, recovery involves managing discomfort and carefully restoring function to the affected limb. Immediately after the procedure, the area is kept elevated to help minimize swelling, and mild pain is managed with prescribed or over-the-counter medication. A splint or bandage is often worn for a period of days to a few weeks to protect the surgical site and limit early movement.
Gentle range-of-motion exercises are often initiated within the first two weeks to prevent joint stiffness, followed by strengthening exercises as healing progresses. Most patients can resume light daily activities within two to four weeks, with a full return to physically demanding work or sports often taking six weeks or longer.
While surgical removal greatly reduces the risk compared to aspiration, recurrence is still possible, though the rate is significantly lower, estimated to be between 5% and 15%. Risks associated with the surgery include potential scar formation, temporary stiffness, infection, or nerve irritation near the incision site.