What Is Ganglion Cyst?

Overview

A ganglion cyst is a soft lump that forms under the skin. Ganglion cysts or synovial cysts, which are sometimes referred to by the peculiar nickname “bible cyst” or “bible bump”  commonly develop in tendons or joints such as the wrist, knees, ankles, and feet.¹ Ganglion cysts contain a thick, gelatinous fluid that can be made up of hyaluronic acid, glucosamine, globulins, and albumin.¹ People assigned females at birth (AFAB) commonly develop ganglion cysts between the ages of 20 and 40, however, they can develop in both people assigned males at birth (AMAB) and AFAB of any age.² While most ganglion cysts are harmless soft tissue masses that sometimes resolve on their own, they can cause pain or affect joint movements.¹ It is therefore important to recognise these benign (non-cancerous) soft-tissue masses and understand how to manage them.

Causes of ganglion cysts

The causes of ganglion cysts are unknown although numerous studies and theories have been conducted and put forward to understand the pathophysiology of the cysts. What is widely agreed upon is that ganglion cysts can develop due to repetitive strain injury in the joints.² The main theory suggests that repetitive strain may cause a tear in the joint capsule, which can lead to leakage of synovial fluid from the joint into local tissue where the gelatinous fluid accumulates within a sac in the tear.² It is also thought that repetitive stress may cause the degeneration of connective tissue or tendons around joints, which leads to an accumulation of mucous fluid, followed by cyst formation. Ganglion cysts are also thought to develop as a result of pre-existing conditions such as arthritis. 

Signs and symptoms of ganglion cysts

Ganglion cysts can develop in four places in the wrist and hand, where they commonly occur. The cysts can grow up to 2 centimetres in size or up to a size of a golf ball. They can develop:¹

• on the back of the wrist
• on the front of the wrist at the base of the thumb
• at the base of a finger
• on the back of a finger or digit, or near the end joint

Common signs and symptoms of ganglion cysts are:

• Noticeable swelling in the wrist, knee, ankle, or feet
• Ache or pain which worsens with activity such as gripping or touching the cyst
• Tingling, numbness, or muscle weakness are thought to occur if the cyst presses on a nerve in the wrist. This may worsen with wrist motion
• The lump enlarges or reduces its size over time

Management and treatment for ganglion cysts

Ganglion cysts are usually harmless and can be left untreated without any long-term health consequences.¹ Around half of all asymptomatic ganglion cysts disappear spontaneously without treatment, but this may take a couple of years.³ Treatment may be required sometimes, especially in people with symptoms of significant pain, discomfort, difficulty with manual dexterity, or where the cyst doesn’t reduce in size by 6 months after diagnosis. It is not surprising that many patients seek prompt treatment to remove the lumps which may appear unsightly, even in cases where the cysts don’t cause symptoms. 

In cases where treatment is required, the first point of call would be to receive a formal diagnosis by a healthcare professional. They may simply examine the cyst or order a scan if appropriate. Thereafter, there are a few medical or surgical treatment options available for ganglion cysts. The treatment often depends on the location of the ganglion cyst and the symptoms experienced.

Pain management

In cases of painful ganglion cysts, the initial treatment option may be to try pain medication such as anti-inflammatory medication. This may help to ease the discomfort.

Aspiration

A non-surgical procedure can be performed on the ganglion cyst to completely drain out gelatinous fluid from the ganglion cyst. This outpatient procedure is usually performed by a doctor who uses a needle and syringe to carefully extrude as much liquid out of the cyst as possible. A plaster is then placed on the skin where the needle was inserted and can be removed around 6 hours after the procedure. Some treatments may include the use of steroids which are thought to lower the chances of ganglion cyst recurrence.⁴  Aspiration is a painless procedure, and this treatment option is usually preferred as it is less invasive than surgery.

Surgery

Surgical options aim to cut out the ganglion cyst. Some ganglion cysts require surgical removal which reduces the chance of the ganglion cysts recurring after treatment.⁵ If the ganglion cyst returns after aspiration, open or keyhole surgery may be considered a treatment option to remove the ganglion cyst. The surgical excision is usually performed by an orthopaedic or hand surgeon as an outpatient procedure.

Ganglion cysts may be aspirated or surgically removed depending on their location. However, ganglion cysts are likely to return⁶ and this informs which treatment option is best to follow:

• Dorsal wrist ganglion cysts: develop on the back of the wrist and are common in young adults. Aspiration can reduce pain and swelling, but the cyst may return
• Palmar wrist ganglion cysts: develop on the front of the wrist and are often seen in individuals with wrist arthritis. The surgery requires care if the cyst is close to the artery in the wrist
• Flexor tendon sheath ganglion cysts: are more common in young adults and usually cause pain when gripping as they are located at the base of the finger and may sit on nerve branches. Surgical removal has a small chance of cyst recurrence
• Dorsal digital ganglion cysts: are also known as digital mucous or mucoid cysts.⁷ These are common in older people. They are located on the back of the finger and have a small chance of recurring after surgical removal

Although ganglion cyst surgical removal is a minor procedure, some side effects may be observed such as infection, scarring, or a weakened grip.³ However, there are options to use a sling or brace for comfort. Hand therapy or physiotherapy can also help the healing process to restore normal hand movement by immobilising the wrist with a splint and performing appropriate hand exercises.

FAQs

How common are ganglion cysts

Ganglion cysts are very common and account for about 60 - 70% of soft tissue lumps found in the wrist or hand.²

Who is at risk of ganglion cysts

Anyone can develop ganglion cysts at any age. However, they are three times more common in AFAB than AMAB aged between 20 and 40 years². People with arthritis of the finger joints are at higher risk of developing ganglion cysts near those joints. Gymnasts and people prone to repetitive strain injuries are at a higher risk of developing ganglion cysts.

How is a ganglion cyst diagnosed

A qualified healthcare professional can diagnose ganglion cysts by examining them or ordering a scan if necessary.

How can I prevent ganglion cysts

Ganglion cysts occur spontaneously and the cause is unknown. Therefore, there is no clinical information on how to prevent them from developing.

When should I call my doctor

Although medical treatment may not be necessary in asymptomatic cases of ganglion cysts, it may be wise to see a doctor if you notice any unusual lumps on your body.

Summary

Ganglion cysts are very common soft tissue lumps that can develop in both AFAB and AMAB at any age. These harmless cysts can go away on their own without medical treatment, however, treatment can be sought from a healthcare professional if the lumps cause significant symptoms. Although there are treatment options for ganglion cysts, they may have a chance of recurring even after the treatment.