Synonyms and Keywords

Ganglion cyst, ganglionic cyst, ganglia, Bible cyst

What is a Ganglion Cyst?

Dating back to medical writing from the time of Hippocrates (c. 460-c. 375 B.C.), the word “ganglion” means “knot” and is used to describe the knot-like bump, mass, or swelling that forms under the skin, often on or around the joints and tendons in the hand or foot. Although ganglions are also known as Bible cyst and the lumps are filled with a thick, clear, jellylike fluid, neither the moniker nor mental image should stir panic since they are non-cancerous, benign, and in most cases harmless.

Ganglion cysts originate from the synovial fluid that is prevalent within the small joints of the wrist or the sheath that surround the wrist tendons. When the fluid happens to leak out from these parts, it can form soft-tissue growth and become cystic. A cyst anchors itself to tendon sheaths with a long, thin tube-like stalk. Nearly 80% of the time, ganglion cysts pop up at the wrist joint, but they also develop on the foot (commonly at the top, with the sole of the foot a rare spot), the outside of the knee and ankles, and fingertips. These compressible sacs, either firm or spongy depending on the size, do not change the skin color above them. They can be painless, and though the fluid inside the lumps can become gelatinous over time, it is similar to the normal fluid circulating within a joint or a tendon sheath. Irritation of the affected tissues can increase the size of a ganglions cyst, but it often can also “disappear” spontaneously.

Ganglion cysts are more likely to affect women than men, as much as three times as often, and patients between 20-40 years of age account for 70% of the cases. On the other hand, they rarely afflict children younger than 10.

What Causes a Ganglion Cyst?

Although the exact cause is unknown, ganglion cysts are thought to occur when tissues surrounding certain joints become inflamed and swell up with lubricating fluid. This is why wrist, fingers, and joints where the fluid frequents are the primary targets of this affliction.

Non-occupational factors or conditions such as rheumatoid arthritis have been linked with ganglion cysts. Occupations that demand excessive or repeated joint movements of the wrist and fingers are also believed to pose a risk — evident by that ganglions are common among gymnasts, whose wrists undergo regular stress. Moreover, there are indications to attribute ganglion cysts to the deterioration of the tissue in the joint that secretes the synovial fluid. Having osteoarthritis, the wear-and-tear variety of arthritis which increases fluid within the joints, can elevate the risk for ganglion cysts too, as will an injury or repetitive blows to the joints or tendons of your hands or feet.

What Are the Different Types of a Ganglion Cyst?

Ganglion cysts are usually categorized into the following types:

Dorsal ganglions, on the top or back side of the wrist, are the most common occurrence, along with volar ganglions, on the front or palm side.

Mucous cysts, on the fingertip just below the cuticle, are generally present with osteoarthritis, hence they are most commonly seen in older patients.

Occult ganglions are smaller, potentially quite painful ganglions that remain hidden under the skin.

What Are the Symptoms of a Ganglion Cyst?

A ganglion cyst is usually soft, 0.4 to 1.2 inches in size, doesn’t move but changes size. When it’s connected to a tendon, you may feel weakness in the affected finger. When it’s on your foot, you may have difficulty fitting into shoes because of the irritation between the lump and the show.

Because the fluid-filled lump presses on the nerves passing through the joint, you may feel nonstop pain and discomfort in that joint, especially after considerable movements that put it through either severe or constant pressure. However, about one out of every three ganglion cysts shows no symptoms other than the unsightly bulge growing out of a joint like a balloon on a stalk.

There can be one large cyst or many smaller ones. While a cluster may appear more threatening because there are more cysts, a common stalk within a deeper tissue usually connects them all. This type of cyst is not harmful and accounts for 50% of all soft-tissue tumors of the hand.

How Do You Diagnose a Ganglion Cyst?

Normally, telltale signs of a ganglion cyst include:

• A noticeable sac
• The lump is round, smooth, and raised near your wrist or finger joints
• Small pea-sized bumps when appearing at the base of the fingers on the palm
• It is filled with fluid, seen by shining a light through the cyst
• It feels tender when pressure is applied
• It becomes larger when you use or exert the affected area, but shrinks when given rest
• A tingling or even burning sensation, if the cyst is touching a nerve
• Dull pain or numbness, indicating the cyst may be pressing against a joint or tendon

A physical exam given by your doctor is usually all that is needed to diagnose a ganglion cyst. A foot and ankle surgeon will perform a thorough examination of the foot in order to diagnose a ganglion cyst. The lump will be visually apparent and should move freely underneath the skin when pressed in a certain way. Occasionally, the surgeon will remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray to rule out conditions such as arthritis or bone tumor. And, because occult ganglion cysts are not visible and the only indicator is pain, ultrasound or MRI may be ordered to complete the diagnosis.

Regardless, it is important to have your doctor examine this type of lump to make sure it is merely a ganglion cyst. While most lumps around the wrist and hand are indeed ganglion cysts, there are other conditions with similar symptoms that will require different, immediate treatments. Other type of tumors such as a lipoma (or giant cell tumor), infections, and bone spur, for example, can also produce lumps around the wrist.

How Do You Treat a Ganglion Cyst?

In many cases, ganglion cysts cause little to no pain and will go away on their own without any treatment other than watchful rest. No emergency treatment is required unless you have significant trauma to the affected area. A routine check by either your primary doctor of a bones-and-joint specialist (orthopedist) should suffice.

When there’s a need for treatment, whether due to pain, difficult joint movement, or simply cosmetic concerns, the process normally consists of removing the fluid from the lump or surgically removing the cyst. Non surgical treatment, arthroscopic surgery, and open surgery have all been utilized to treat ganglion cysts, with arthroscopy leading the way and providing some promising results, particularly in preventing the recurrence of dorsal ganglion cysts.

Self-Care at Home

An alleged home remedy for ganglion cyst suggests hitting the lump with a large heavy book to rupture it and drain its content into the surrounding tissues. Since that large heavy book used is often supposedly the Holy Book, it gave rise to the ganglions’ nickname of “Bible cyst,” along with “Jillian’s lump,” “Bible bumps,” and “Gideon’s disease.” This, though, is not recommended, for the thumping can damage the area around the cyst and lead to a higher chance of recurrence (as well as undue embarrassment!).

Neither is popping or puncturing a ganglion cyst with a needle or sharp object yourself a viable alternative, as this is unlikely to be effective and can cause infection.

A better, more preferable option is to actually do nothing, particularly if the cyst is painless and does not interfere with walking or regular movements. It is quite common for ganglion cysts growing on the top of the wrist, the underside of the wrist between the thumb and your pulse point, and at the end joint or base of a finger to fade harmlessly away without surgical treatment. Ganglion cysts are not cancerous, therefore will not spread to other parts of your body. So, watchful waiting, coupled with resting the affected hand or foot and refraining from activities that seem to worsen the pain, is usually enough. A wrist brace or splint that minimizes motion of the affected area and decreases pressure on the nerves will cut the cyst down in size and speed up the recovery.

For a ganglion cyst-plagued foot, wearing shoes that do not rub or irritate the lump is advised. Additionally, place a pad inside the shoe to help reduce pressure against the cyst.

If the pain is getting to you, consider taking over-the-counter pain reliever such as Tylenol or ibuprofen (Advil, Motrin, etc.).

Topical Professional Treatments

First, be prepared to answer some questions. You and your doctor should have more time to discuss any particular concerns if you’re ready with the answers to the following:

• When did you first notice the lump?
• Do you have any pain or tenderness?
• Is it hindering your ability to use your joint?
• What, if anything, seems to improve your symptoms?
• What, if anything, seems to make your symptoms worse?

When the ganglion wall is thin and in the early stages, a doctor may choose to compress it by hand until it bursts and the fluid is absorbed — not a pleasant thought, but this is the least invasive treatment.

Or the doctor can perform aspiration, a slightly more invasive approach that typically includes placing a needle into the cyst to draw the liquid out, injecting a steroid compound (hyaluronidase) for anti-inflammatory purpose, and splinting the affected area to keep it from moving, for 3-7 days. The drawback is that the gelatinous fluid does not always come through a needle very well, and leaves the cyst to return at a greater than 50% chance. The cure rate jumps to 85%, however, when a patient undergoes at least three aspirations.

A third, moderately invasive procedure is cyst puncture. In this treatment, the medical professional passes a suture vertically through the skin and the cyst, then leaves it there for three weeks. Despite a 95% cure rate, this procedure is not widely used because it increases the risk of infection.

All non surgical treatments leave a ganglion’s outer shell and the stalk intact, however, so it may reform and reappear.

Surgical Treatments

Ganglion cysts are the second most common elective referral to a surgeon, behind only carpal tunnel. Doctors will perform surgical removal of a ganglion cyst when other treatment options fail or are inappropriate. It is necessary when the mass becomes intensely painful, interferes with motor functions (especially when involving the dominant hand), causes numbness or tingling of the hand or fingers, or forms a one-way valve that lets the fluid enter but not leave to persistently enlarge the cyst (which is usually the reason for surgical removal).

The outpatient procedure normally involves removing the cyst(s) through a small incision, into which the surgeon inserts a camera (arthroscope) to view the area, or through a larger incision to directly observe the cyst(s) and surrounding area. Arthroscopic surgery is becoming more common because it leaves a smaller scar and requires a shorter healing time.

After a surgery, your joint will mostly likely be splinted for up to 7-10 days. The hard wrap will keep you from moving the joint during the interim. Your doctor may request your return for a checkup after the surgery and will decide if physical or occupational therapy is necessary. Follow-up care will depend on your personal needs.

However, while surgery gives the lowest chance for recurrence, there is no guarantee a cyst will not grow again. A surgery may also include removing part of the involved joint capsule or tendon sheath. This, in addition to possible post-surgery soreness, discomfort, and swelling, means a patient should not expect to resume normal activities for two to six weeks afterward.

How to Prevent a Ganglion Cyst?

Not knowing the exact cause of a ganglion cyst makes the affliction difficult to prevent. As medical professionals recommend early evaluation and treatment, it behooves you to check with your doctor at the earliest opportunity when the symptoms arise. With a proper diagnosis, your doctor can help decide on the best treatment plan for you and keep you from unnecessary anxiety.