Ganglion Cyst

Background

A ganglion cyst is a fluid filled mass or lump that tends to grow out of the joints, tendon sheaths, or joint linings. It is the most common hand mass accounting for 60-70% of all masses of the hand. The most common place to find a ganglion cyst is on the back of your hand (dorsal) but can also occur on the palmar surface of the wrist (volar) or from the joints of the fingers. These form as a result of the body walling off an increased production of fluid at the given site forming a fluid filled sack which often fluctuates in size.

Treatment

Treatment options include non-surgical and surgical options.

Non surgical treatment: Surgery is indicated for neurovascular compromise, pain or cosmetic reasons. Therefore, in the absence of pain or neurovascular compromise, observation is a reasonable approach. In children, most cysts will resolve over the next year. These cysts are sometimes called “Bible cysts” due to references of treatment via closed rupture (smashing the cyst) with a bible. This method is ineffective, painful and has a high recurrence rate. Aspiration of the cyst with subsequent steroid injection can be attempted for dorsal cysts, but results vary widely and there is a high chance of recurrence of the cyst.

Surgical treatment: Despite the risk of recurrence, albeit relatively low, surgical treatment remains the most reliable method of removing a cyst. The surgery, known as cyst excision, provides the best results as it allows for removal of the sac. A small incision is made over the cyst and the sac is carefully dissected out. The wound is closed and a plaster splint is placed which will be removed at the initial postoperative office visit at 2 wks. At the initial postoperative visit, the dressings are removed and you will be allowed to get the incision wet in clean running water (no submerging in water x 4 wks or until the wound is completely healed). We recommend no strenuous activity x 4-6 wks in order to allow complete healing of the wound.