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.
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%.
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.
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 Cysts
Ganglion cysts are common. If cysts are painful, we recommend at least two aspirations before surgery. You should find a doctor specialising in diagnosing a ganglion cyst and performing cyst aspiration with ultrasound. Remember, not all practitioners who perform injections are doctors. Do your homework first.
My daughter has a similar case of ganglion cyst but we never visit any surgeon we didnt inquire to anybody until i research it and found your page. My daughter said its not painful so i never frighten but one day she said mom i think its become big so become nervous …i dont know what to do…please help me sir
Hi Thank you for your email. Most ganglions are not painful but might become painful if they get bigger or press on structures in the wrist eg nerves, tendons. I’d suggest an ultrasound to make sure it is a ganglion. Then you and your daughter can decide on whether to do something about it. Lorenzo
I just recently found out the other day , that I have a ganglion cyst. It came larger over a year of having it and very painful. So they gave me several options after X-rays were taken. I decided to have it aspirated because I’m trying to avoid surgery. I have to wear a brace over my hand and wrist for four weeks before I return to my doctor.
Hi Londy, I think aspiration is a definite option if you want to avoid surgery. Lorenzo
Hi doctor i have lumps on my wrist and i dont have may idea what is that im experiencing pain mostly in cold times what should i do? Pls give me some advise.. Thank u
Any unexplained and painful lump should be investigated. I’d suggest an ultrasound. These lumps could be cysts (ganglions0 or they could be solid massess. An ultrasound will differentiate between the two. LM
I have been Aspirating and draining my ganglion cyst on my thumb for years removing the clear fluid with the needles.
Hello Dr. I just left an ortho appointment for a ganglion cyst. I never noticed it on my right thumb until after I had suffered a lifting injury at work. Can the cyst have came from the injury?
Hi Cynthia, Yes ganglions can arise from trauma or injury.
LM
Hi,
i’m at of noticing a lump on my hand and my wrist on both sides? i’m so upset and down because i’m so scared if it’s going to effect my health, my doctor said the one on my hand is a cysts but today i noticed the both sides of my wrist are sore and a lump on each side are really at of appearing out of no where? i’m starting to feel a bit of pain on my right hand wrist? should i be concerned
Hi Amanda, you should get an ultrasound to see if the lump is a cyst. if it is, then you have nothing to worry about.
LM
Thanks. Good article. In Usa. Rectus femoral cyst.
I had a ganglion cyst on the arch aspirated about a month ago by a podiatrist. It immediately came back but now this time there is a growing pool of blood presumably where I was injected. Should I return? If he aspirated again, do I have to continue coming back? Is this going to be a lifelong thing I have to deal with? Just want to know what I’m in for!
Hi Thanks for the comment. Yes i’ve had a few cases where the cyst had re-accumulated almost immediately after a complete aspiration.
I suspect most of these cases are bleeding into the cyst.
Generally, I re-aspirate followed by compression and ice.
LM