The diagnosis of a ganglion is usually based on the location of the lump and its appearance. They are usually oval or round and may be soft or very firm. Cysts at the base of the finger on the palm side are typically very firm, pea sized nodules that are tender to applied pressure, such as when gripping any object. Light will often pass through these lumps (transillumination) and can assist in the diagnosis.

Wrist or hand x-rays may be requested in order to investigate problems in adjacent joints. Cysts at the end joint of the finger frequently have an arthritic bone spur associated with them. Very rarely MRI may be needed.

Ganglion cysts can be treated conservatively or surgically depending upon patient’s problems.

Conservative treatment:

Simple observation is advised for asymptomatic ganglions. These can disappear spontaneously.

Anti-inflammatory painkillers - taken as needed during painful phase of ganglion cyst

Wrist splint - used for supporting the painful wrist and avoiding movements which cause pain.

Aspiration of ganglion cyst - done if there is increase in the size of the cyst and pain that limit regular activities at home and work. Aspiration can be done in the OPD with all sterile precautions. A needle is used to puncture the sac and suck out the fluid within it.

Aspiration decompresses the cyst and reduces pain. There is possibility of recurrence of the cyst after aspiration.

Surgery is advised for:

• large sized painful ganglions causing cosmesis issues
• symptomatic ganglion cysts that have failed to respond to conservative treatments
• recurrence of ganglion after aspiration.

The ganglion can be removed either by open surgical technique or arthroscopically.

Surgery involves removing the fluid filled sac along with part of the underlying joint capsule or tendon sheath. There is a 5 to 10 % chance of recurrence after excision of the ganglion.