Ganglion cysts are fluid-filled capsules that form most commonly 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. When should you aspirate a ganglion cyst? When is a ganglion cyst aspiration 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 production of fluid, 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 area of the body. 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 confirm 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 of nuance or cosmetically unappealing. However, not all lumps are ganglion cysts. It is important to get the lump checked with ultrasound to make sure it is a simple ganglion cyst.

Can a ganglion cyst go away? 

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

How to treat a ganglion cyst

Sometimes, ganglion cysts just go away. Other times, they grow larger for no particular reason. As they grow larger, they can cause pressure on other structures causing pain or other symptoms. Ganglion cyst treatment is only needed if patients are concerned about the appearance or the cyst is 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 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, using ultrasound is useful to make sure all the fluid is aspirated. Also, seeing the track of the needle prevents injury to closely located tendons or nerves. The disadvantage of ganglion cyst aspiration 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 coming back.

aspiration of ganglion cyst on ultrasound

Can you get ganglion cysts in the foot?

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

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

ganglion compressing tarsal tunnel on MRI

Ganglion cyst aspiration vs surgery: which is better? 

Overall, the most aggressive treatment is the complete removal of the ganglion. It is important to remove all the lining of the sac 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 ganglion cyst aspirations before surgery.

Other commonly asked questions about a ganglion cyst: 

Do ganglion cysts go away on their own?

Sometimes. In some cases, the ganglion cyst can burst or just disappear. In other cases, it can increase 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 a little more worrying. You should see your doctor if you have a lump that is growing in size and becoming more painful.

Can you see a ganglion cyst on 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.

Final word from Sportdoctorlondon about ganglion cyst aspiration

Ganglion cysts are common. If cysts are painful, we recommend at least 2 aspirations before surgery. You should find a doctor with expertise in diagnosing and aspirating cysts 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.

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