Ganglion Cysts

Ganglion cysts are fluid-filled lumps beneath the surface of the skin. These lumps appear near joints and tendons and don't usually cause any symptoms, often resolving themselves.

What are Ganglion Cysts?

Sometimes referred to as a bible cyst, a ganglion cyst develops just below the skin and usually results from a tear in the tissue that covers a tendon or joint. When these tears occur, a small, fluid-filled lump will appear. It’s important to note that ganglia (plural of ganglion cyst) aren’t cancerous and are usually harmless, but can be sometimes painful when the joint moves.

Ganglion cysts can develop at different joints, most often at the:

Wrist: On the front or back of the wrist joint
Finger: Near the palm or just below the fingernail
Foot: Closer to the ankle or near the toes

In some cases, ganglion cysts will develop so small that they may be difficult to see, but can be painful nonetheless. These small cysts are known as occult ganglions and are generally found using an MRI or ultrasound.

Ganglion Cyst Symptoms & Causes

As ganglion cysts are often painless and asymptomatic, the usual and primary symptom is a bump beneath the skin which can vary in size and shape. On occasion, these lumps will grow larger when the joint moves or if it is left untreated. Pain can sometimes be a ganglion cyst symptom, though it can be painless as well, as the pain is generally perceived as muscle pain or a tingling sensation due to the pressure from the cyst.

The cyst is usually firm but can be moved easily under the skin, though is sometimes described as feeling soft as it is fluid-filled.

The primary cause of a ganglion cyst is unknown but is thought to be from a previous joint or tendon injury that allowed tissue to leak or bulge. Certain factors have been identified that increase the risk of a person developing ganglion cysts, such as:

People assigned female at birth are three times more likely to develop a ganglion cyst than those assigned male at birth.
Ganglion cysts typically appear in early to mid-adulthood, between ages 20 and 50.
Arthritis: Having arthritis in the hands increases the risk of a ganglion cyst, which typically appears near the fingertips.

Ganglion cysts cannot be prevented as the direct cause is unknown and they are not dangerous. The cyst is considered to be a benign mass and is treated as such.

Diagnosis & Treatment Options

Diagnosing a ganglion cyst typically involves a physical exam where the healthcare provider will examine the lump’s appearance and location as this type of cyst mostly occurs at specific joints. During the exam, the doctor may press on the cyst and shine a light to see if it’s translucent and may order an X-ray to see if there are any signs of arthritis near the joint. In rare cases, the doctor may perform a biopsy for further analysis.

Treatment for ganglion cysts is predominantly conservative and an at-home approach, usually including:

Anti-inflammatory medication to help minimize swelling and discomfort from the cyst.
Aspiration: an outpatient procedure where the cyst is drained in the doctor’s office, but as it only drains the fluid and doesn’t remove the cyst, the symptoms may return.
Splints or braces for better support and prevent moving the affected joint, helping to reduce the swelling and pain

Ganglionectomy: Surgical Treatment

When conservative and at-home treatments fail or the ganglion cyst returns, a ganglion cyst surgery called ganglionectomy may be recommended. This surgery removes the entire cyst instead of draining the fluid and is an outpatient procedure that can be performed using open techniques or arthroscopy (tiny incisions).

Recovery takes between two and six weeks, often resolving the symptoms with little chance for the cyst to return since it was entirely removed.

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