A ganglion cyst is a non-cancerous, fluid-filled lump that commonly develops near joints or along tendon sheaths, most often found on the wrist or ankle. This mass is a sac filled with a thick, jelly-like substance similar to joint fluid. Treatment is individualized, depending on the cyst’s size, location, and whether it causes pain or limits joint function. Managing this condition requires a coordinated approach involving several medical professionals.
Initial Medical Assessment
The first point of contact for a suspected lump is typically a Primary Care Physician (PCP) or a general practitioner. The PCP performs a physical examination to assess the lump’s characteristics, including size, firmness, and mobility. They may also use transillumination, where a light is shined on the lump, confirming it is fluid-filled rather than a solid tumor.
The initial assessment focuses on ruling out other potential causes for the swelling, such as a lipoma, a soft tissue tumor, or an infection. Diagnostic imaging is often ordered to confirm the diagnosis and provide anatomical detail. While an X-ray checks for underlying bone issues like arthritis, a high-resolution ultrasound is the preferred modality. Ultrasound visualizes the cyst’s fluid-filled nature and its precise connection to the nearest joint capsule or tendon sheath. This workup determines if the cyst is asymptomatic, requiring observation, or if a referral to a specialist is necessary.
Specialists Handling Non-Surgical Care
If the cyst is symptomatic or causes cosmetic concern, the patient is typically referred to a specialist, such as an Orthopedic Surgeon or a Hand Specialist. These practitioners are trained in musculoskeletal conditions and manage conservative treatments. For many patients, the initial recommendation is “watchful waiting” because some ganglion cysts resolve spontaneously without intervention.
If intervention is needed, the most common non-surgical procedure is needle aspiration. This minimally invasive technique involves numbing the area and using a needle to puncture the cyst to drain the viscous, gel-like fluid. Aspiration is often performed under ultrasound guidance to ensure accurate needle placement, especially when the cyst is located near a neurovascular bundle. While aspiration quickly shrinks the cyst and relieves pressure, the recurrence rate is high (50 to 85 percent) because the procedure leaves the cyst’s connecting stalk intact.
Surgical Removal of the Cyst
Surgery, known as a ganglionectomy, is reserved for cysts that are recurrent, cause significant pain, or impair joint function despite conservative management. This procedure is performed by specialized surgeons, most often an Orthopedic Surgeon or a Plastic Surgeon trained in hand and wrist surgery. The objective is to remove the entire cyst sac along with the small stalk that connects it to the joint capsule or tendon sheath.
The surgeon may employ an open excision technique, which involves a single incision, or a minimally invasive arthroscopic (keyhole) approach, particularly for certain wrist locations. Removing the stalk significantly reduces the chance of the cyst returning. Post-operative recurrence rates are much lower than with aspiration, typically 7 to 28 percent. The procedure is usually performed on an outpatient basis, allowing the patient to return home the same day.
Long-Term Monitoring and Follow-Up
Following active treatment, whether aspiration or surgery, a period of monitoring and rehabilitation is initiated by the treating specialist. The surgeon checks the incision site for proper healing and removes any non-dissolvable sutures, generally within one to two weeks. The patient is monitored for signs of infection or complications such as stiffness.
Physical Therapists (PTs) or occupational therapists play a role, especially after surgical excision, to help restore full function. Therapy focuses on a structured program of exercises designed to prevent joint stiffness, manage scar tissue formation, and regain strength and range of motion. The long-term plan involves the treating specialist or the PCP conducting surveillance for any sign of cyst recurrence.