A ganglion cyst is a non-cancerous, fluid-filled sac that forms near a joint or tendon sheath, most commonly on the wrist, hand, or ankle. These masses contain a thick, gelatinous fluid similar to that found in joints. While many cysts are asymptomatic, treatment decisions are influenced by whether the mass causes pain, limits function, or creates cosmetic concern. Understanding which medical professionals are involved is the first step in managing a ganglion cyst, as the care pathway shifts based on severity and planned intervention.
Initial Assessment and Diagnosis
The process of determining the nature of a lump usually begins with a Primary Care Physician (PCP). The PCP starts with a thorough physical examination, evaluating the mass for size, mobility, tenderness, and its connection to underlying structures. They will also take a detailed history of symptoms, including when the lump first appeared and if it causes pain or weakness.
To confirm the diagnosis and rule out other potential causes, the PCP may order diagnostic imaging. X-rays are routinely used to ensure the mass is not related to a bone issue, such as a fracture or arthritis. For masses that are ambiguous or deep-seated, an ultrasound or Magnetic Resonance Imaging (MRI) scan may be ordered, often by a specialist. Once a diagnosis is confirmed, the PCP decides whether observation is appropriate or if a referral to a specialist for further management is necessary.
Non-Surgical Management Providers
When a ganglion cyst is small or not causing severe symptoms, the first recommended approach is often observation, as nearly 60% of cysts may resolve spontaneously. If the cyst is symptomatic or growing, an orthopedic specialist is the most common provider to manage non-operative care. These specialists focus on the musculoskeletal system and are well-equipped to handle the differential diagnosis of soft tissue masses.
The primary non-surgical intervention is aspiration, which involves using a sterile needle to drain the thick, jelly-like fluid from the cyst. While some PCPs may attempt this, it is frequently performed by an orthopedic specialist or an interventional pain management physician due to the proximity of neurovascular structures. Aspiration is often combined with the injection of a corticosteroid medication to help reduce inflammation. Aspiration has a high recurrence rate, sometimes up to 90%, because the connection (stalk) to the joint capsule remains intact.
Surgical Intervention Specialists
Surgical excision is typically reserved for cysts that recur after aspiration, cause persistent or severe pain, or significantly impair nerve or joint function. The specialists who perform this definitive treatment are most often Orthopedic Surgeons and Hand Surgeons. Hand Surgeons possess highly specialized training for the intricate anatomy of the wrist and hand, where most ganglion cysts occur.
The goal of the surgery is the complete removal of the cyst and its connection (stalk) to the joint capsule or tendon sheath. Removing this stalk is crucial to minimizing the chance of the cyst returning. Surgeons may use an open technique, which involves a single incision, or an arthroscopic technique, which uses smaller incisions and a miniature camera. While surgery carries a lower recurrence rate, it is an invasive procedure with a longer recovery compared to non-surgical methods.