Ganglion Cyst

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Published: September 30, 2013
Last reviewed: March 8, 2017

What is ganglion cyst? Definition and Etymology

In Greek, ganglion means a ball-shaped swelling or knot under the skin 1. A cyst is a closed fluid-filled sac that is formed in the tissues 2. A ganglion cyst is a noncancerous fluid-filled sac that arises from the muscle tendon, tendon sheath, joint capsule or ligament, most commonly on the wrist or foot 3. NOTE: Ganglion cysts have nothing to do with neural ganglions, which are clusters of neural cells inside the body.

Ganglion cysts grow due to an accumulation of fluid within them and not because of uncontrolled cell growth, like benign tumors (lipoma, for example) do 3. Ganglion cysts also do not spread and invade surrounding tissues, like cancers do. In most cases, a ganglion cyst is not dangerous but may cause stiffness or pain in the affected joint 3.


Ganglion Cyst Picture

Picture 1. Ganglion cyst on the back side of the left wrist
(source: Wikipedia, Creative Commons license)

Synonyms

Ganglion cyst may also be called:

  • Bible cyst or bump, because they were used to be treated by slamming with a heavy book, such as Bible 4 or Gideon Bible (and hence Gideon’s disease).
  • Ganglionic cyst
  • Ganglion
  • Mucous cyst, when it appears on the end knuckle of the finger
  • Baker’s cyst or popliteal cyst, when it appears on the back of the knee.

NOTE:

  • Synovial cyst arises from the joint synovial sheath and is a true cyst (covered by epithelium on the inner side), so it is not the same as a ganglion cyst, but the appearance and treatment for both are similar, so they are often used as synonyms 29,45,65. A ganglion cyst (without epithelium) can also arise from a synovial sheath, though.
  • Bursal cyst arises from the bursa; its inner side is covered by epithelium, so it is not the same as a ganglion cyst, but the two are often used as synonyms 11,64,65.  A ganglion cyst (without epithelium) can also arise from a bursa, though.

Locations

A ganglion cyst can develop in any joint, muscle or bone, but most common locations are shown in the Picture 2 below:

Ganglion cyst location picture

Picture 2. Typical ganglion cyst locations
(free image use)

The Wrist

Wrist ganglion cysts most commonly appear on the dorsal (back, top) side, but also on the volar (palmar) side of the wrist 5. Wrist ganglions usually arise from the muscle tendons but sometimes from the wrist bones 7.

Ganglion Cyst on Wrist Picture

Picture 3. A ganglion cyst on the palmar side of the wrist
(source: eatonheand.com)

Ganglion cyst on wrist Image

Picture 4. A ganglion cyst arising from the tendon sheath on the wrist
(free image use)

The Foot

Common locations: The top of the foot 5 or, rarely, on the bottom of the foot (sole) 27 or back of the heel in the Achilles tendon 52,66

Ganglion Cyst on Foot Picture

Picture 5. A ganglion cyst in the foot
(source: webmedcentral.com, Creative Commons license)

Ganglion Cyst on Foot Picture

Picture 6. A ganglion cyst in the foot
(source: Wikipedia, Creative Common license)

The Fingers

Ganglion cysts can appear on the fingers or thumbs, either on the base of the finger (palm side) or on the end knuckle (back side) — in the later case it is called mucous cyst 3,5.

The Knee

Ganglion cysts on the knee can appear on:

  • Back of the knee (Baker’s or popliteal cyst) 10,11

ganglion cyst baker mri

Picture 7. An MRI image of a ganglion cyst behind the knee (Baker’s cyst)
(source: scielo.br, Creative Commons license)

 

Other locations of ganglion cysts in the knee:

  • Front of the knee (in the patellar tendon) 9,11 or in the anterior crucial ligament (ACL) 14
  • In the tendon of quadriceps femoris muscle above the knee 62
  • Meniscus 15

The Ankle

ganglion cyst ankle

Picture 8. A ganglion cyst within the bone in the ankle
(source: faoj.org, Creative Commons license)

Other Locations

  • Other joints, such as shoulder 16, elbow (inner side) 69, hip (a cyst appears in the groin) 50, or ankle (inner or outer) 5, axilla (armpit) 64, jaw (a lump arises from the temporomandibular joint and appears in front of the earlobe) 55
  • A disc in the lumbar spine, mostly in young men – it can cause sciatic pain (sciatica) 8
  • The femur (the bone in the thigh) 6 or humerus (the bone in the upper arm) 32
  • The quadriceps muscle in the thigh 63 or gastrocnemius muscle in the calf 33

Symptoms and Signs

Some ganglion cysts are hidden within the joints (occult cysts) and are not visible or palpable and may or may not cause symptoms 3. An occult cyst on the wrist may show up when you bend the wrist 47. Symptoms may include 3,4,5,7,25,52,53:

  • A visible lump, pea- to plum-sized, covered with normal skin, which is not red or warm. A cyst may become bigger with joint activity and smaller with joint rest; a cyst disappears spontaneously in up to 58% cases 3,4,25,26. A cyst may rupture when you hit it accidentally; this usually causes no problems, but the cyst often returns.
  • On palpation, a cyst can be soft or firm, movable or fixed, tender or not.
  • Often a cyst causes constant dull pain (ache) in the joint and moving the joint can hurt. Pain from the wrist may radiate up to the arm 25.
  • A cyst can cause stiffness and limited motion, snapping, catching or locking of the affected joint and may affect hand gripping or walking 3.
  • When a cyst on the palmar side of the wrist presses upon the median nerve, it may cause tingling in the thumb, index and middle finger (carpal tunnel syndrome); when it presses on the ulnar nerve, it may cause tingling in the pinky and ring finger (Guyon’s canal syndrome).
  • When a cyst is attached to a tendon, it may cause muscle weakness in the affected finger or toe.
  • A ganglion cyst arising from the hip joint may appear as a groin mass, which may pulsate, and when it presses upon the femoral nerve, it can cause groin pain or tingling 50,51.

Pathology and Pathophysiology

A ganglion cyst may originate from 3,4,29:

  • A tendon, which is a band of connective tissue that joins a muscle to a bone
  • A tendon sheath
  • A ligament, which is a band of connective tissue that connects bones in joints
  • A joint capsule 3,4
  • Rarely, ganglion cysts develop within the bones (intraosseous cyst), most commonly on the wrist bones 7, but also in the femur 6 or humerus 32,  cartilaginous discs in the spine 8, muscles (mainly in the calf) 15,33,34 or nerves 17,35.

A ganglion cyst is like a balloon on a stalk, filled with a translucent, jelly-like fluid. This fluid may originate from the synovial fluid normally present in the joint, but this is not certain 25. A cyst can be rounded or oval and it can be small like a pea or large like a golf ball. You can have one or multiple cysts in one joint or in more joints at the same time 11. Cysts do not spread from one area to other, though 3.

The fluid from the joint may move into the cyst but not vice versa, so this is why a cyst can grow larger with the joint activity 25.

Histology and Cytology

The wall of the cyst is made of collagen (the predominant molecule in the connective tissue) and fibrocytes (cells that produce collagen) 25. There are no epithelial cells on the inside of the cyst wall, so ganglion cysts are not true cysts but pseudocysts 25. The fluid within the cyst is made predominantly of water, hyaluronic acid, glucosamine, mucin and proteins 25,46. There is usually no or only little tissue inflammation in and around the cyst 25. A ganglion cyst is very rarely calcified 43,44.

Causes and Risk Factors

The exact cause of ganglion cysts is not known. The prevailing opinion is that ganglion cysts are caused by degeneration of the connective tissues in the joint, probably due to chronic irritation or minor trauma, such as pressure from the shoes or landing on the hand with an extended arm 7,11.

Risk factors include 3,5,7,18,25,31:

  • Age 15-40 years, especially in women, but cysts can occur at any age (rarely in children under the age of 10 — when they occur, they disappear spontaneously within a year in about 80% cases) 47
  • Repetitive strain injury of the joints, for example in gymnasts or athletes, or repetitive wrist use in computer users 41 and guitar players 42.
  • Tendon injury
  • Some people believe a ganglion cyst can develop in association with the De Quervain’s tendonitis, which is an inflammation of the tendons at the base of the thumb and which, when it occurs in mothers who take care of their newborns, is called “mother’s wrist” 40.
  • A single trauma may result in the development of a traumatic ganglion cyst:
    • In a 25-year-old footballer who was hit into the peroneal muscle on the outer side of the calf, a ganglion cyst with bumpy swelling developed in the muscle 38.
    • Slamming with the door can result in a cyst on the wrist 39.
    • Some orthopedics believe wearing shoes with high heels increases the risk of injury that can result in the formation of a ganglion cyst 54.

Diagnosis

Physical Exam

A doctor observes and palpates the cyst and shines through it by using a penlight (transillumination) — most ganglion cysts are translucent (Video 1) 3,7. In most cases, a doctor can make a diagnosis of a ganglion cyst by a physical exam alone without further investigations 25.

Ganglion Cyst on Finger Picture

Picture 9. Transillumination of a ganglion cyst (mucous cyst) on the finger
(source: eatonhand.com)

Aspiration

In doubtful cases, a doctor may check the content of the cyst by aspiration a small amount of fluid using a needle and syringe. When the obtained fluid is not clear as expected, it can be sent to the laboratory and investigated under the microscope (cytologic investigation) 12.

Imaging

  • Ultrasound is a quick and cheap procedure, which can reliably show a ganglion cyst 3,5.
  • Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) can reliably show a ganglion or mucous cyst, but are rarely needed and are expensive 3,5,13.
  • X-ray does not show a ganglion cyst but can rule out dense structures, such as tumors and bone spurs 3. Cysts on the end finger knuckles are often associated with bone spurs 3.

Differential Diagnosis

Abnormalities that can resemble a ganglion cyst 11,13,31,43:

  • Benign tumor, such as neuroma, lipoma, fibroma, chondroma, schwannoma, hemangioma, osteoma (they are not translucent)
  • Epidermoid cyst
  • Plantar fibromatosis
  • Rheumatoid nodule (in rheumatoid arthritis, systemic lupus erythematosus)
  • Viral wart
  • Keratinous horn
  • Foreign body granuloma
  • Abscess, which is a pus collection after local infection (the skin above the abscess can be red and warm)
  • Subcutaneous granuloma annulare
  • Xanthomas, which are lipid deposits in individuals with hypertriglyceridemia (yellowish appearance).
  • Bone spur or osteophyte (hard)
  • Bone cyst (hard)
  • Gouty tophus (usually very painful)
  • Ulnar or radial artery aneurysm (pulsating)
  • Adventitious bursa
  • Calcific tendonitis
  • Myositis ossificans
  • Giant cell tumor, which is a benign (noncancerous) but aggressive tumor (hard)
  • Nevus within the skin
  • Plexiform fibrohistiocytic tumor, which is a malign tumor under the skin

Lumps in the Neck

A lump in the neck is rarely a ganglion cyst; it is more likely an abscess (after infection in the mouth or throat), enlarged lymph node or a thyroid nodule, goiter or cancer.

Ganglion vs Cancer

Ganglion cysts are translucent when you shine a light through them, but cancers and benign tumors are not.

Treatment

Painkillers

When a cyst hurts, over-the-counter (OTC) painkillers, such as aspirin or ibuprofen, may help. Holding an ice pack (wrapped in a cloth, not directly to the skin) over the cyst for 20 minutes few times a day may also provide pain relief 60.

Wrist Braces or Splints

Wrist brace or splint prevent wrist mobility and may reduce pain and may, eventually, lead to a reduction of the cyst size 3.

Manual Compression

A doctor may press upon a soft cyst with fingers until it bursts 25,70. Doctors rarely use this method nowadays. Do not try to pop a cyst by yourself because you may cause damage to the nearby nerves 7.

Puncture of the Cyst

A puncture (acupuncture) of the cyst is rarely performed nowadays; a doctor pushes a suture perpendicularly into the wrist, and the cyst is allowed to drain for several days 7,25,70.


Video 1. Puncture of the cyst

Cyst Aspiration

Aspiration is mainly used to treat cysts on the back of the wrist (Video 2) and in the foot 21. A primary doctor or orthopedic surgeon cleans the skin above the cyst, injects a local anesthetic near the cyst and drains the cyst fluid by using a needle and a syringe. After aspiration, a doctor may inject a steroid into a cyst — this is supposed to reduce the chance of the cyst recurrence, but this has not been proven 25. Cysts on the palmar side of the wrist may be guided by an ultrasound to avoid injury of the radial artery 25. A doctor will place a bandage over the puncture, and you can leave the hospital right away and continue with your activities. The whole procedure may require you to stay in a doctor’s office for about 30 minutes.

In about half of the cases, after aspiration, the cyst will be filled with fluid in some time 3. When a cyst is aspirated three times, in about 80% cases it will be cured permanently 4,5. Splinting the wrist after the cyst aspiration has not been proven beneficial and may actually prolong the stiffness of the wrist 25. According to one study, immobilization after cyst aspiration does not reduce symptoms or prevent cyst recurrence 48.


Video 2. Aspiration of a dorsal wrist ganglion cyst:
local anesthesia and aspiration

Surgery — Ganglion Cyst Removal (Ganglionectomy)

Cyst excision, which is usually an outpatient procedure, which lasts about 15 minutes, involves removing the cyst, its stalk and often a part of the tendon sheath or joint capsule from which the cyst originates with the scalpel 3 or laser 56,70. A surgeon will close the wound with sutures and wrap the operated area with a bandage. You can usually go home in few hours after the procedure 3.

  • In open surgery, an orthopedic surgeon makes about 2 inches (5 cm) cut through the skin and removes the cyst (Video 3) 3.
  • In an arthroscopic or keyhole surgery, an operator pushes a thin endoscope with a camera and instruments at the end through a small incision in the skin into the joint and removes the cyst 3. Arthroscopic surgery usually results in less pain after a procedure and a shorter scar than open surgery 3,36.

Surgery can be performed under local or regional anesthesia (you are awake during the procedure) or general anesthesia (you fall asleep) 68.


Video 3. Surgical removal of a ganglion cyst from the top of the wrist: preparation, excision, sutures, bandage.

Recovery After Wrist Ganglion Surgery

You might need to wear a sling or splint for 3-7 days after an operation to avoid an injury to a surgical wound and to give time for swelling to go away 7. A bruise, swelling and tenderness in the operated area may persist for few days. At around day 10 after surgery, you will need to have stitches removed. Do not lift any objects heavier than a pound before sutures are removed 61. Pain on the wrist may persist for several weeks 4. Persistent swelling or joint stiffness may require physiotherapy. The incision leaves a permanent scar, which can be thick, red and numb, and, in some individuals, a small area around the scar will also be permanently numb 22.

  • In the first three days after an operation, holding an ice pack over the wound dressing (NOT directly on the skin) may reduce swelling 59.
  • Recovery time after wrist ganglion removal may range from few days to six weeks, depending on how extensive the surgery was and how much you use wrists during work 3,4,23.
  • You may be able to drive after 2-4 weeks 22.
  • A doctor or physiotherapist may suggest you specific exercises to maintain the mobility of the joint and massage of the scar to prevent adhesions.
  • A surgical wound may need about 2 months to heal completely.

Recovery

  • After removal of a cyst from the top of the foot or big toe, you may be able to walk straight away 24.
  • After removal of a cyst from the bottom of the foot, you might need to wear an offloaded surgical shoe for 2-3 weeks 24.
  • Do not smoke during recovery. Nicotine causes narrowing of the blood vessels and may greatly prolong healing of the surgical wound 24.

The Cost of Surgery

The cost of ganglion cyst removal surgery may vary greatly and depends on the hospital, the type of anesthesia used and the difficulty of operation.

  • In the United Kingdom (UK) the cost (as of September 2013) may range from 1,300 to 1,750 £ (British pounds) 28.

Prognosis and Complications During and After Surgery

Possible complications of the ganglion cyst surgery 4,7,25,26:

  • Damage to the radial artery during operation of the cyst on the palmar side of the wrist
  • Damage to the median or ulnar nerve on the wrist resulting in carpal tunnel or Guyon’s canal syndrome with numbness or tingling (paresthesia) in fingers
  • Infection of the joint or surgical wound
  • Allergic reaction or other side effects of anesthesia
  • Permanent pain and stiffness of the joint
  • Decreased range of motion in the joint, decreased grip strength
  • Neuroma — a benign tumor that develops from the nerve
  • Recurrence of the cyst in 10-48% of cases, much more likely after the removal of the volar than dorsal wrist cysts 37. When the associated part of the synovial sheath from which the cyst arises is removed as well, the recurrence rate may be as low as 4%. According to one study, a volar wrist ganglion cyst can recur as early as in one month or as late as after 12 years 49.
  • A surgery leaves a scar, which can be sometimes thick and red (keloid) or tender 37.
  • Laser surgery may result in less bruising and scarring than a surgery by a scalpel 57.

Arthroscopic surgery results in less pain and a smaller scar than open surgery, but the recurrence rate is about the same in both types 7,36.

Natural Home Remedies

WHAT CAN YOU DO:

  • If you have a cyst on the foot, you can try new, more comfortable shoes.

DO NOT DO THIS:

  • Do not pop a cyst with a needle, since you may not be sure if it is a cyst at all, and because you can cause a cyst infection 2.
  • Do not try to burst a cyst by slamming it with a heavy object like a book because you can cause damage to the nearby nerves 2.

Homeopathic and Holistic Treatment

There is a lack of scientific evidence about the effectiveness of homeopathic or holistic methods in curing ganglion cysts.

Prevention

The exact cause of ganglion cysts is not known, so currently, no prevention guidelines exist 58. If you practice yoga you should avoid certain positions with leaning on your hands. Avoiding shoes with high heels may help prevent cysts in the foot.

ICD 9 and ICD 10 Code

Cyst Type ICD 9 ICD 10
Ganglion and cyst of synovium, tendon and bursa (Ref 19) 727.4
Synovium cyst, unspecified (Ref 19) 727.40 M71.30
Ganglion of joint (including mucous cyst) (Ref 20) 727.41 M67.419-M67.479
Tendon sheath ganglion (Ref 19) 727.42 M67.419-M67.479
Ganglion, unspecified (Ref 19) 727.43 M67.40
Other ganglion and cyst of synovium, tendon and bursa (Ref 19) 727.49 M71.30

CPT (Current Procedural Terminology) Codes

  • Ganglion cyst aspiration = 20612
  • Excision of primary ganglion cyst on the wrist= 25111
  • Excision of recurrent ganglion cyst on the wrist =25112
  • Excision of ganglion cyst from the hand or finger = 26160
  • Reference 30

Summary

  • A ganglion cyst often disappears spontaneously.
  • Aspiration usually results in symptoms relief, but the cyst may return in up to 50% cases.
  • A surgery is currently the most effective cure for a ganglion cyst, but it leaves a scar, stiffness and pain in the joint may persist or even worsen, and the cyst may return in 4-48% cases.

17 thoughts on “Ganglion Cyst”

  1. john says:

    hello,I have a growth on the left back side of my,head.I went for a medical checkup,and the doctor said it is a ganglion.please tell me what could it be and how I can have it removed.

    1. Jan Modric says:

      John, first you need to get an exact diagnosis from a specialist (your primary doctor can lead you where to go). If it is actually a ganglion cyst, it can be removed by a minor surgical procedure.

  2. Kevin says:

    Most primary care offices will be able to aspirate (remove the fluid with a needle) in their office. If your provider doesn’t do this, they can recommend someone who can.

    In my primary care office, this is typically a 30 minute appointment which includes consultation and the procedure together in one visit.

  3. jennifer mims says:

    My doctor tells me I have an arthritic cyst in my talas. I had an mri. He has given 2 cortisone injections and recommends no more. He gave me a perscription for an orthopedic in my shoe. So I’m doing that. Can such a cyst be aspirated? Also I am getting cold laser treatments. The doctor who diagnosed the cyst is an orthopedic surgeon. What is the difference between an arthritic cyst and a ganglion cyst? Can an arthritic cyst benefit from laser treatments and if so, about how many should suffice? And do patients who have surgery to remove an arthritic cyst develop further pain after surgery?

    1. Jan Modric says:

      Jennifer, “arthritic” cyst is any cyst in the joint, so this term reveals only it’s location. There are several types of arthritic cysts, one of them is a ganglion cyst. To know which exactly you have, you would need to ask the surgeon.

      Most cysts can be aspired–in this case only the fluid is removed, but the membrane and the stalk are still there, so aspired cysts often recur. The cyst can be also completely surgically removed. If the cyst is the cause of your pain, its removal would result in pain relief, but your surgeon can tell you some statistics about this. Even surgically removed cysts can recur. The more completely the cyst is removed, the less likely it will recur.

      Laser treatment might be as effective as aspiration, but I have no real information about this. The problem is that cysts treated by these “lighter” approaches often recur. In general, conservative (non-surgical) treatments of ganglion cysts are not very effective. Sometimes, a cyst heals spontaneously, but I can’t say if this can happen in your case.

  4. Kathryn Hilb says:

    I have ganglion cysts on top of left goot,Dr.want to drain,how long is re covery n how pain ful

    1. Jan Modric says:

      Kathryn, you get local anesthesia, so it should not be painful more than like getting a vaccine. Recovery should be very short, because it’s just a puncture and that’s it. Cysts that are drained often recur, though.

  5. Sayantan Banerjee says:

    How to get rid of a dorsal ganglion cyst?

    1. Jan Modric says:

      Sayantan, a quick way is with aspiration – a doctor can drain it using a needle.

  6. I had a Ganglion removed from my wrist, just over a month ago. As it is healing, small scabs have formed and there is some puss underneath the scabs (that I can see). The rest of the scar is healing ok, due to its location it is taking longer to heal than expected. Shall I go to the doctors to get this checked out?

    1. Jan Modric says:

      Samantha, yes, a wound can get infected and this is maybe happening.

  7. Camille says:

    I have a Ganglion Cyst on the inside top of my left wrist. In the past, when it has gotten to a certain size, it will disappear. When it disappears, it is strange because one day it is there and then the next it isn’t and I’m like “where did it go?”. However, this time, it has grown bigger than it has in the past and shows no signs of disappearing. Also, in the past, it was never really bothersome, but now it is. I guess because it is bigger and putting pressure on surrounding nerves and ligaments, etc. It is painful when I move my wrist a certain way and it hurts especially if I put my hand flat on a table and put pressure on the hand by pressing downward. I have seen articles where people have gotten the cysts drained, but they almost always return, but I am not sure I would want to have the entire cyst removed because I have seen photos of some pretty massive scars too. I don’t know what to do- anyone have any ideas??

    1. Jan Modric says:

      Camille, your previous cyst probably popped on their own. You know the options – draining or complete removal, so it’s on you to decide. You can contact a doctor and ask about a scar.

  8. Debra Williams says:

    I have large balls of fluid on the outside of both ankles a physiotherapist said they are ganglion cysts but the doctor disagrees. They have appearecd and grown in the last 10 years though i have always been overweight i havent had these lumps . They dont hurt but are so unsightly people ask what they are

    1. Jan Modric says:

      Debra, a doctor can try aspirate some material from the bump and send it to histological investigation to see what exactly it is. If it’s not a ganglyon cyst, it can be a lipoma (a nondangerous benign tumor composed of fat), or some other type of cyst, for example.

      In this article you can scroll down to picture 6 and see that a ganglion cyst is partially translucent when you shine through it by a torch. A lipoma is not translucent.

  9. Mollie says:

    I had a ganglion cyst surgically removed and 3 months later it came back with a vengeance. I can barely move my finger and the pain is unbearable.

    1. Jan Modric says:

      To permanently cure a ganglion cyst, it should be completely removed (with its wall). If it is only drained, it typically recurs.

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