Ganglions

What are ganglions?

Ganglions are small sacs (cysts) filled with clear, jellylike fluid that often appear as bumps on the hands and wrists. They can also develop on feet, ankles, knees, or shoulders. They are not cancerous. A ganglion can grow out of a joint capsule, which surrounds and protects the joint, or a tendon sheath, which covers the tendon (the ropelike fibers connecting muscle to bone). Most people with ganglions notice that the bumps appear suddenly.

See an illustration of a ganglion.

Ganglions may be as small as a seed or larger than a cherry. A ganglion on the leg may get as big as 4 in. (10.2 cm). Ganglions may grow as activity increases, because more fluid collects in the sac. They may also shrink and may break and go away on their own.

One common type of ganglion, called a mucous cyst, occurs with osteoarthritis of the hands. This type of ganglion is usually found at the joint nearest the fingernail (distal interphalangeal [DIP] joint). The size of mucous cyst ganglions may get as large as a small green pea and may be painful.

Anyone can get a ganglion: adults between 15 and 40 years old are most likely to be affected.¹ Women are affected three times as often as men.² Children do not usually have ganglions, but if they do, the ganglion will very likely go away without any treatment.

What causes ganglions?

Experts do not know the exact cause of ganglions but believe they may be associated with:

• Inflammation or irritation of the tendon sheath or joint capsule.
• An injury.
• Overuse or repetitive motions, such as those you do at work.
• Osteoarthritis (degenerative joint disease), especially mucous cyst ganglions.

What are the symptoms?

Ganglions are usually small, painless bumps, but they may be tender to the touch.

Sometimes there can be pain, which increases with activity or pressure. This is because the ganglion puts pressure on the nerves that pass near the joint. This pressure on the nerves may also cause tingling in the fingers, hand, or forearm. Some ganglions can weaken your grip or affect joint motion.

How are ganglions diagnosed?

A ganglion can usually be diagnosed by its appearance and location. Your health professional will also feel the bump and shine a light alongside it. If the bump is a ganglion, the light usually shines through it (transillumination).

An X-ray may be done if your health professional suspects osteoarthritis or injury but will not be done only to diagnose the ganglion. Some of the fluid found in the ganglion may be removed and examined. In rare cases, magnetic resonance imaging (MRI) or ultrasound is used to evaluate unusual ganglions.

How are they treated?

Ganglions usually do not need treatment and often go away on their own. If they are painful, limit activity, press on nerves, or are unsightly, your health professional may recommend nonsurgical treatment, such as wearing a splint, massaging the ganglion to reduce the fluid within the bump, or draining it with a needle and syringe (aspiration). Ganglions can also be surgically removed.

Frequently Asked Questions

Most ganglions are small, painless bumps. Usually they do not cause serious symptoms. A ganglion:

• May be tender when pressure is applied.
• Can usually be moved under the skin from side to side, unless it is on a finger.

See an illustration of a ganglion.

Mucous cyst ganglions, which usually occur with osteoarthritis of the hands, are firm and not easily moved under the skin. They can become infected, resulting in increased swelling, redness, and pain.

A ganglion can usually be diagnosed by its appearance and location and by feeling the bump. Your health professional will also ask questions about your medical history and do a physical exam. In some cases, an X-ray or other imaging test may be needed.

Your health professional may shine a light alongside the bump. If the bump is a ganglion, the light usually shines through it (transillumination). Your health professional may ask you how long you have had the ganglion and whether it changes in size or is painful, and he or she may apply pressure to see if it is tender.

An X-ray may be used to:

• Determine changes in bone near the ganglion. Occasionally ganglions can damage wrist or finger bones and ligaments.
• Check for other conditions, such as a bone spur (a small, bony growth that forms along a joint), a bone tumor, or osteoarthritis.

In rare cases, an ultrasound or magnetic resonance imaging (MRI) is used to evaluate unusual ganglions and ensure that a tumor is not present.

A ganglion can also be diagnosed by draining the fluid (aspiration) and evaluating it. The ganglion may temporarily go away after the fluid is removed, but it is likely to come back.

Ganglions usually do not need treatment. Because a ganglion is not cancerous and may disappear with time, your health professional may recommend watching the ganglion to be sure nothing serious develops while waiting for it to go away.

Treatment may be needed when a ganglion:

• Causes pain. The pain may be aching rather than sharp and may increase with activity.
• Interferes with activity. Ganglions may weaken your grip or limit joint motion.
• Affects sensation by pressing on or irritating a nerve. You may feel tingling in your fingers, hands, or forearms.
• Becomes infected. This is more common with osteoarthritis mucous cysts.
• Is unsightly.
• Affects the wrist bones, finger bones, or ligaments.

Nonsurgical treatment is usually tried first. It may include:

• Wearing a wrist or finger splint off and on for several weeks. This limits movement of the wrist or hand, which helps reduce the fluid that collects within the ganglion sac. This may be all that is needed for the ganglion to shrink and disappear on its own. Do not put the splint on too tight because it can affect the blood supply to the wrist and hand. Signs that the splint is too tight include numbness, tingling, increased pain, or coolness in the hand. Constantly wearing a splint for more than a few days may also cause muscle wasting, known as atrophy.
• Massaging the ganglion. Rubbing the ganglion gently but often during the day may help move the fluid out of the sac. Do not smash a ganglion with a book or other heavy object. You may break a bone or otherwise injure your wrist by trying this folk remedy, and the ganglion may return anyway.
• Draining the fluid from the ganglion with a needle (aspiration). This may be followed by a corticosteroid injection. This treatment is rarely a permanent solution because the ganglion sac remains intact and will usually fill again, causing the bump to return. A health professional may pierce the ganglion sac with the sterile needle three or four times so the sac will collapse completely. Infection is possible after this procedure.
• Injecting the joint with hydrocortisone if the ganglion occurs with osteoarthritis (mucous cyst). This reduces inflammation and possibly decreases the chance of the ganglion returning.

Ganglions often return. Ganglions on the wrist may return in up to 9 out of 10 people using nonsurgical treatment.¹

Surgical treatment

If a ganglion returns after nonsurgical treatment, surgical removal may be needed. The goal of surgery is to remove the ganglion sac and the connecting tissue that allows the fluid to collect. Ganglions return in about 5% to 10% of people after surgery.¹ This may happen if the connecting tissue is not completely removed. A new ganglion may also form near the site of the removed ganglion. Infection and injury to other tissues are rare, but possible, risks of surgery.

A mucous cyst ganglion is treated by removing the ganglion fluid (aspiration) or surgical removal. Bone spurs (small, bony growths that form along a joint) are often present in the joint next to a mucous cyst, and removing bone spurs makes it less likely that the cyst will return. The chance of infection is higher in mucous cysts.

What to Think About

Ganglions are the most common noncancerous soft-tissue bumps on the hands and wrists. Ganglions are usually painless and do not cause other symptoms. After being reassured that the ganglion is not a symptom of a more serious condition, many people do not seek further treatment.

Ganglions may disappear without any treatment and may return with or without treatment.

Some people seek treatment for their ganglion because it is unpleasant to look at.

After a ganglion has been diagnosed, home treatment includes:

• Wearing a wrist or finger splint off and on for several weeks. This limits movement of the wrist or hand, which helps reduce the fluid that collects within the ganglion sac. This may be all that is needed for the ganglion to shrink and disappear on its own. Do not put the splint on too tight because it can affect the blood supply to the wrist and hand. Signs that the splint is too tight include numbness, tingling, increased pain, or coolness in the hand. Constantly wearing a splint for more than a few days may also cause muscle wasting, known as atrophy.
• Massaging the ganglion. Rubbing the ganglion gently but often may help move the fluid out of the sac. Do not smash a ganglion with a book or other heavy object. You may break a bone or otherwise injure your wrist by trying this folk remedy, and the ganglion may return anyway.

A ganglion may become infected if you break it open. Occasionally, a ganglion may break open on its own. If this happens, home treatment may be all that is needed.

• Use an antibiotic ointment, such as polymyxin B sulfate (for example, Polysporin) or bacitracin, and a bandage. Apply the ointment lightly to the wound. The ointment will keep the skin from sticking to the bandage. Stop using the ointment if a rash or irritation develops under the bandage; the rash may be caused by an allergic reaction.
• Prevent infection by washing the affected area 2 to 3 times a day. Apply a sterile bandage at least once a day or when the bandage gets wet or soiled. If a dressing is stuck to a scab, soak the dressing in warm water to soften the scab and make removal easier. If available, use a nonstick dressing, such as Telfa.

Call your health professional if signs of infection develop. These include:

• Increased pain, swelling, redness, or warmth around the affected area.
• Red streaks extending from the affected area.
• Drainage of pus from the area.
• Swollen lymph nodes in the armpit or groin.
• Fever or chills with no other known cause.

Organizations

• Osteoarthritis

Citations

1. American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2005). Ganglia of the wrist and hand. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 362–367. Rosemont, IL: American Academy of Orthopaedic Surgeons.

2. Tallia AF, Cardone DA (2003). Diagnostic and therapeutic injection of the wrist and hand region. American Family Physician, 67(4): 745–750.

Other Works Consulted

• Bednar MS, Light TR (2003). Ganglion section of Hand tumors. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 594–595. New York: Lange Medical Books/McGraw-Hill.