Ganglion cysts, also called bible cysts, are benign lumps on the hand. They are not cancerous, and in most cases, completely harmless. They can occur in various locations but occur most often in the wrist and hand. They can come out of nowhere and can disappear just as quickly. If the ganglion cyst pops up near a nerve, it can cause severe pain. If the cyst is not near the nerve, then it may not cause pain. There are both surgical and nonsurgical treatment options available. Nonsurgical treatment options will be recommended, followed by surgical treatments if nothing else works.
Ganglion cysts are most commonly a mass or lump on the hand. They are not cancerous and in most cases completely harmless. A ganglion rises out of a joint, similar to a balloon. It grows out of the tissues, specifically the ligaments and joint linings, surrounding a joint. Inside the cyst, there is a thick, slippery fluid.
Ganglion cysts most commonly develop in the wrists and hands. They vary in size and can get bigger with increased wrist activity. With rest, these cysts will typically become smaller.
Although the causes of ganglion cysts are unknown, we do know they are most common in younger people typically between the ages of 15 and 40 years old. Additionally, women are more likely to be affected than men. These cysts are also common among people who do rigorous activities that apply stress to the wrist, such as gymnasts.
Ganglion cysts that develop at the end joint of a finger — also known as mucous cysts — are typically associated with arthritis in the finger joint and are more common in women between the ages of 40 and 70 years.
Most ganglion cysts will form a visible lump. Smaller ganglion cysts can remain hidden under the skin. These types of ganglion cysts are known as occult ganglions. If the cyst puts pressure on the nerves that pass through the joint, they can cause pain, tingling, and muscle weakness.
Your Florida Orthopaedic Institute physician will take a look at your symptoms and overall medical history. They will also ask you how long you have had the ganglion cyst, whether it changes in size, and whether it is painful.
Your physician may also order some test to confirm for diagnosis. These tests include:
- X-rays. These tests create clear pictures of dense structures, such as bone. Although x-rays will not show a ganglion cyst, they can be used to rule out other conditions that may be causing your symptoms.
- Magnetic resonance imaging (MRI) scans or ultrasounds. These imaging tests will actually show soft tissues, such as a ganglion cyst.
Many ganglion cysts do not need treatment. But if the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available. There are both surgical and nonsurgical treatment options available. Non-surgical treatment options would be recommended, followed by surgical treatments if other approaches do not work.
There are three main steps to treating a ganglion cyst. These steps are:
- IMMOBILIZATION. Activity often causes the ganglion to increase in size and also increases pressure on the nerves. Your physician may prescribe a brace or splint to help keep pressure off the cyst.
- ASPIRATION. If the ganglion causes severe pain or limits activities, the fluid can be drained from it to help reduce symptoms. This process is known as aspiration. Aspiration frequently fails to eliminate the ganglion because the “root” or connection to the joint or tendon sheath is not removed. A ganglion can be like a weed which will grow back if the root is not removed. Often the ganglion cyst returns after an aspiration procedure.
If your symptoms are not relieved from nonsurgical treatments, your physician may recommend that you get surgery.
Surgery involves removing the cyst as well as part of the involved joint capsule or tendon sheath, which is considered the root of the ganglion. Even after excision, there is a small chance the ganglion will return.
Excision is typically an outpatient procedure. Patients are able to go home after a period of observation in the recovery area. There may be some tenderness, discomfort, and swelling after surgery. Normal activities usually may be resumed 2 to 6 weeks after surgery.