A ganglion cyst is a non-cancerous, fluid-filled lump that commonly forms near joints or tendons. These soft tissue masses contain a thick, jelly-like fluid similar to joint lubricant. They most frequently appear on the back (dorsal) or front (volar) of the wrist and hand, but can also occur on the ankle or foot. While often asymptomatic, they may cause pain, tingling, or weakness if they press against a nearby nerve or interfere with joint function.
Initial Diagnosis and Specialist Referral
The first step in addressing a suspected ganglion cyst involves an evaluation by a primary care provider. The physician performs a physical examination, assessing the lump’s size, mobility, and tenderness. A common diagnostic technique is transillumination, where a light shined through the fluid-filled mass makes it appear translucent, distinguishing it from a solid tumor. To confirm the diagnosis and rule out issues like arthritis, the physician may order imaging tests. X-rays evaluate adjacent bone structures, while Ultrasound or Magnetic Resonance Imaging (MRI) scans offer a detailed view of soft tissues and can locate small, non-visible cysts (occult ganglions). If the cyst causes discomfort, limits movement, or if the diagnosis is uncertain, the primary care provider refers the patient to a specialist, usually an orthopedic surgeon or a hand specialist, depending on the location.
Non-Surgical Management and Aspiration
Initial treatment is often conservative, starting with observation if the cyst is not causing pain or functional issues, as many resolve naturally. Immobilization, using a splint or brace to restrict movement, is another non-surgical approach that can cause the cyst to shrink and relieve nerve pressure. This approach is temporary, as long-term immobilization can lead to muscle weakness. If symptoms persist, the least invasive option is aspiration, performed in an outpatient setting. Aspiration involves numbing the skin before inserting a needle to drain the thick, gelatinous fluid. Specialists, such as a hand surgeon, orthopedic surgeon, or rheumatologist, often perform this procedure, sometimes using ultrasound guidance. The primary drawback is the high recurrence rate, ranging from 50% to over 90%, because the cyst’s connection to the joint or tendon sheath remains intact.
Surgical Excision and the Operating Specialist
Surgical excision is considered when a ganglion cyst causes significant pain, restricts joint movement, or returns after aspiration. The specialists performing this definitive removal have expertise in the affected area. For cysts on the hand and wrist, this is typically a fellowship-trained Hand Surgeon or a general Orthopedic Surgeon. If the cyst is on the ankle or foot, a Podiatrist or Foot and Ankle Orthopedic Surgeon handles the procedure. The goal of excision is to completely remove the cyst sac and its “stalk” or root, which connects it to the joint capsule or tendon sheath. This complete removal significantly reduces the chance of recurrence. Surgery can use an open technique (a single, larger incision) or an arthroscopic technique (small incisions and a camera). Arthroscopic excision, a minimally invasive option, is popular for dorsal wrist cysts as it allows the surgeon to visualize joint structures during removal.
Post-Procedure Recovery and Recurrence Risk
Recovery depends on the removal method. After aspiration, patients typically resume light activity immediately but should avoid strenuous activity for about a week. For surgical excision, recovery involves keeping the area bandaged or splinted for several days to weeks to protect the incision and limit joint movement. Immediate pain and swelling are common and managed with elevation and medication. A full return to normal activity takes two to six weeks after surgery, and physical therapy may be recommended to regain strength and range of motion. While surgery provides a much lower risk of recurrence than aspiration, the cyst may still return because the underlying cause of the fluid leak remains. Recurrence rates after surgical excision are generally between 5% and 20%, a substantial improvement over aspiration rates.