Ganglion cysts are fluid-filled capsules that commonly form on the top of wrists. However, these cysts can form around any joint or tendon. Removing the fluid – also called aspiration of a ganglion cyst – is an option if the cyst becomes large or painful. Often, we perform ultrasound-guided aspirations of ganglion cysts.  When is ganglion cyst drainage worth it?

What causes a ganglion cyst? 

Ganglion cysts are not true cysts but arise from joints and tendon sheaths. We suspect that degeneration within a joint or tendon sheath leads to increased fluid production, called synovial fluid. As a result, this fluid leaks out and produces a fluid-filled sac called a ganglion cyst. This fluid is thick and jelly-like.

Generally, most lumps in the wrist are ganglions. However, other causes of lumps include growths such as giant cell tumour, lipoma, or even nerve cell tumours.

Symptoms of ganglion cyst

Most ganglions are symptom-free. They are first discovered as a pain-free lump on the wrist or another body part. If the lump grows, it may press on surrounding structures such as tendons and nerves, producing pain, numbness, or tingling.

Often, we suggest imaging to confirm a diagnosis of a ganglion cyst. In general, ultrasound or MRI can establish a simple fluid-filled sac and exclude solid tumours such as giant cell tumours or lipomas.

Is a ganglion cyst dangerous? 

Generally, these cysts are more nuance or cosmetically unappealing. However, not all lumps are ganglion cysts. Therefore, getting the lump checked with ultrasound is crucial to ensure it is a simple ganglion cyst.

Can a ganglion cyst go away? 

So yes, some ganglion cysts keep growing while others disappear. So treatment is not essential for all ganglion cysts.

How to treat a ganglion cyst

Sometimes, ganglion cysts go away. Other times, they grow larger for no particular reason. They can cause pressure on other structures as they grow, causing pain or other symptoms. Therefore, ganglion cyst treatment is only needed if patients are concerned about the appearance of the cyst causing symptoms.

Most doctors advocate no treatment, especially if the ganglion is small. Ganglions are harmless, and most patients are reassured that the cyst is not sinister.

One home remedy that is traditional but somewhat bizarre is hitting the cyst with a hard book such as a bible. This attempt at removal pops the cyst rupturing the cyst lining. However, the trauma can damage other structures and is not recommended.

Aspiration of a ganglion cyst is an option.

aspiration of ganglion cyst

Generally, aspirating the fluid from the cyst is an option. This procedure is also called ganglion cyst aspiration. We use a large needle as the fluid in the cyst is thick and difficult to remove with a smaller needle. In general, ultrasound-guided aspiration of a ganglion cyst is helpful to make sure all the fluid is aspirated. Also, seeing the needle track prevents injury to closely located tendons or nerves. The disadvantage of ganglion cyst drainage is that the cyst may return in 50% of cases. However, injecting a small dose of cortisone into the residual sac after ganglion cyst aspiration can prevent it from returning. Generally, the risk of recurrence after an ultrasound-guided aspiration of a ganglion cyst and cortisone injeciton is about 30-40%.

Steroid injection for ganglion cyst

Is it worth injecting a steroid after aspiration of a ganglion cyst? We think so. Steroid injection for a ganglion cyst reduces the chance of recurrence by at least 10%.

ultrasound-guided aspiration of ganglion cyst on ultrasound

Can you get ganglion cysts in the foot?

Yes. You can get ganglion cyst anywhere in the body. However, the wrist and the foot or ankle are the most common places.

Below is a picture of a ganglion cyst that has formed inside the ankle. The cyst was causing pressure on the nerves on the inside of the ankle. The male athlete described pain inside the ankle and pins and needles traveling into the foot. We performed an aspiration of ganglion cyst with a needle and with good results.

ganglion compressing tarsal tunnel on MRI

Cyst aspiration vs. surgery: Which is better? 

Overall, the most aggressive treatment is the complete removal of the ganglion. It is essential to remove all the sac lining to prevent a return. Nevertheless, despite this, the recurrence rate after surgery approaches 25%. So, most doctors suggest simple non-surgical treatments, including one or two ultrasound-guided ganglion cyst drainage before surgery.

Other commonly asked questions: 

Do ganglion cysts go away on their own?

Sometimes. In some cases, the ganglion cyst can burst or disappear. In other cases, it increases in size. If it doesn’t hurt or is not a problem cosmetically, then we suggest you leave it alone.

Can a ganglion cyst cause pain?

Yes, but only if it grows in size and pushes on other structures, such as nerves or tendons. However, a painful lump could be caused by something more worrying. So, you should see your doctor if your lump grows and becomes more painful.

Can you see a ganglion cyst on an X-ray? 

No. An X-ray will only show the bones of the wrist. Generally, an ultrasound or MRI is needed to confirm a ganglion cyst.

How much rest from sport do you need after the aspiration of a ganglion cyst? 

It depends on the sport, where, and size of the cyst. Generally, if the cyst is in large weight-bearing tendons or joints such as the ankle or feet, we suggest a week’s rest from impact activity or sport. However, you’ll only need a few rest days for office-based work.

What are the risks or side effects of a ganglion aspiration? 

Risks include infection (less than 1/100000), damage to other structures such as nerves or tendons, and recurrence (50% chance). Other dangers of injecting cortisone in the sac include fat atrophy and skin depigmentation. However, using ultrasound reduces these risks by improving the accuracy of aspiration and avoiding important structures.

How fast can a ganglion cyst grow back after aspiration? 

The time for a ganglion cyst to grow back can vary. Sometimes, the cyst reappears after days to a few weeks. Other times, it takes weeks or months to appear. We think that lower limb cysts are more likely to recur quickly.

A final word from Sportdoctorlondon about ganglion cyst aspiration

Ganglion cysts are common. If cysts are painful, we recommend at least two aspirations before surgery. You should find a doctor specializing in diagnosing a ganglion cyst and performing cyst aspiration with ultrasound. Remember, not all practitioners who perform injections are doctors. Do your homework first.

Other hand conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.