Ganglion Cysts

Ganglion cysts are a common cause of wrist pain. Ganglion cysts can sometimes be occult, or hidden, while others are easily visible with the naked eye. Visible ganglion cysts often present as a smooth, round lump under the skin at the wrist level. The lump may change in size over time and appear to get larger with certain wrist motions. Ganglion cysts are benign and do not need to be removed if they are not painful or bothersome. Occult ganglion cysts are more difficult to diagnose, but with the help of MRI and a trained eye our doctors can determine its location and size. When the location of an occult cyst correlates with your pain this helps verify that the cyst is the cause. Sometimes a ganglion cyst may be seen on MRI, but it is not causing any symptoms, in which case nothing needs to be done.

Ganglion cysts are abnormal sacs of fluid that form near a joint. The fluid inside the sac is a clear jelly like substance called synovial fluid. Synovial fluid is normal “joint fluid” that helps to lubricate and reduce friction so that our joints move smoothly. Ganglion cysts can cause increased pressure inside a small joint and this leads to pain that is usually associated with particular wrist motions or weightbearing. Often times, patients will initially notice the pain while doing yoga or exercises in which they are putting weight through their wrist in an extended position. As time goes on they may feel pain during daily activities such as cooking and driving. Generally, this is the time that the patient comes to our office.

Our doctors will take time to carefully examine your wrist. Many times, if the cyst is small or occult, there will be no obvious mass or deformity, while other times the cyst may be very obvious. X-rays may be taken in our office and usually there are no abnormalities. There may be point tenderness over the area of the cyst and pain with certain motions. If our doctors are suspicious of a cyst they may order a wrist MRI to further evaluate your issue.

After the MRI, you will return to our office to review your images. Our doctors will take their time going through the images and explain where the cyst is located and the structures surrounding it. They will discuss several treatments and help guide you in deciding which option is best for you. The most conservative option for treating a painful ganglion cyst is using a wrist brace throughout the day to see if that gives adequate relief. If a ganglion cyst is easily identifiable, our doctors can attempt aspirating the cyst (draining with a needle) and potentially injecting it with cortisone. The cortisone will decrease the inflammation surrounding the cyst and therefore decrease your pain. This option may resolve the issue, although often times the cyst will return and need to be addressed surgically.

Ganglion Cyst Excision​ – Modern Orthopaedics of New Jersey, Wayne, Parsippany, Dr. Peter DeNoble MD and Dr. David Ratliff MD. Orthopedic Surgeons, Hand SurgeonOccult, or hidden, ganglion cysts are sometimes more difficult to deal with. Generally, a painful occult cyst will need to be addressed with surgical intervention. This involves making a small incision over the area of the cyst and removing the cyst sac and deeper stalk that emanates from the joint. Recovery following a ganglion cyst excision is fairly straightforward. You will likely rest the wrist in a splint for a week or two and then gradually return to your daily activities. It may take a couple of months to return to heavy exercises and full weightbearing on the wrist that is pain free, but our patients report that it is worth the wait.

Ganglion cysts can be very bothersome and painful. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. So instead of the old adage of smacking your ganglion cyst with a book, come and visit our doctors who will diagnose and treat your wrist problems with precision and superior care.

Ganglion cyst excisions are usually done with a small open procedure directly over the cyst. On some occasions, they are removed arthroscopically depending on the cyst’s location and size. Once the cyst is visualized, instruments are used to excise the cyst sac all the way down to the stalk. Removing the cyst stalk helps to ensure that they cyst will not recur. Generally, you will wear a small splint for the first week after surgery. Once the splint is removed, you will begin to regain your motion and strength frequently with a home exercise program. Full recovery generally takes a few weeks, although you may return to most activities as tolerated after your first follow up visit.