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Hand and Wrist Ganglions

Ganglions are by far the most common lumps in the hand and wrist. They are not cancers and don’t turn into cancers. They are filled with a jelly like material and can be soft, firm or even feel hard.

The most common sites are:

  1. The back of the wrist. (Dorsal Wrist Ganglion) see opposite.
  2. Palm side of wrist (Volar Wrist Ganglion).
  3. Near the tip of the finger around the nail (Mucous Cyst).
  4. Around the tendons in the finger (Flexor Sheath Ganglion).

The cause is usually not clear but they may appear after an injury. Often they cause no symptoms but can be painful if pressed on by surrounding structures. This may occur with heavy activities or extremes of motion.

Diagnosis

  • Usually clinical.
  • Ganglions tend to occur in characteristic locations.
  • Often plain x-rays are obtained to ensure no bony abnormalities.
  • Ultrasound will help with diagnosis, location and likely place where the cyst arises from. Occasionally an MRI for deep-seated cysts.

Treatment

  • Based on symptoms and location.
  • The reasons to remove ganglions are for pain, dysfunction and cosmesis.
  • They may spontaneously resolve so observation is an option if it is not symptomatic.Aspiration / Injection, quoted 50% recurrence rate.
  • Surgical Resection, 5-10% recurrence rate.
  • This can be done open or arthroscopically.

The old fashioned treatment (especially dorsal wrist ganglions) was to hit with a large book to “pop” the cyst, traditionally a bible.

These notes have been prepared by orthopaedic surgeons at OrthoSport Victoria. They are general overviews and information aimed for use by their specific patients and reflects their views, opinions and recommendations. This does not constitute medical advice. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.