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Finger and Hand Ganglion Cysts
Understanding the small, firm ganglion cysts that form in the palm at the base of a finger, and how they differ from wrist ganglions.
What are Finger and Hand Ganglion Cysts?
Finger and hand ganglion cysts are outpouchings (perhaps able to be likened to a hernia or bulge) that generally develop from a joint, but sometimes develop from a flexor tendon sheath.
A finger or hand ganglion cyst may be able to be felt, or not able to be felt. It may be visible or not visible. It may cause symptoms, or be found incidentally on an ultrasound or MRI.
A ganglion of a flexor tendon sheath arises from the sheath surrounding a flexor tendon, which is different from the joint-related origin of others ganglions, and it behaves differently too: these cysts are usually smaller, firmer, and tend to stay a fairly constant size rather than fluctuating.
Finger and Hand Ganglion Cysts at a glance
What is it?
A cyst within the finger or hand that arises either from a joint, or a flexor tendon sheath
Common symptoms
A small, firm lump in the palm or finger, which may be tender when gripping or pressing on it
Who it affects
Most common in middle-aged adults, and more common in women
Is it serious?
Not dangerous and benign, but can be tender and noticeable with gripping activities
Treatment options
Observation, aspiration, or surgery
First step
A consultation and examination to confirm the diagnosis
Symptoms and how Finger and Hand Ganglion Cysts present
The main feature is a small, firm, pea-sized lump. It is often tender when gripping objects or pressing directly on the lump. Cysts from the joint may fluctuate in size over time (get bigger and smaller). Cysts from the flexor tendon sheath often stay a similar size over time. The cysts can cause compression on nearby structures, which can lead to numbness, tingling or pain if a nerve is compressed or irritated. They can arise when there is inflammation or irritation of the adjacent joint or tendon.
Causes and risk factors for Finger and Hand Ganglion Cysts
- More common in middle-aged adults
- More common in women
As with wrist ganglions, the exact trigger is often unclear, and many appear without any obvious cause.
How are Finger and Hand Ganglion Cysts diagnosed?
A ganglion of the flexor tendon sheath is usually diagnosed on examination, based on its characteristic firm, small, tender appearance at the base of a finger. Some cysts are clearly a ganglion, because they fluctuate in size on examination and are soft. Some are a non-specific lump, and in this setting it is routine to investigate further with an ultrasound examination, to determine whether the lump is consistent with a fluid filled ganglion, or whether it is a solid lump (tumour).
Treatment options for Finger and Hand Ganglion Cysts
Observation is a reasonable option if the lump is not bothersome.
Aspiration under ultrasound guidance by a radiologist is sometimes attempted, but can be technically difficult given the small size and firmness of these cysts, and the lump often returns.
Surgical excision, removing the cyst from the tendon sheath, is a small and effective procedure and is generally recommended for lumps that are persistent, tender or bothersome. The precise location of the ganglion cyst will determine what type of dressing is applied after surgery, what the post operative restrictions are, recommendations for post operative rehabilitation and the likelihood of recurrence.
When to see a hand surgeon about Finger and Hand Ganglion Cysts
It is worth being assessed if you have a tender lump in the palm at the base of a finger, especially if it is affecting your grip or is otherwise bothersome.
What to expect at your Finger and Hand Ganglion Cysts appointment
At your appointment, Dr Tomlinson will examine the lump and any imaging that you have had done to confirm the diagnosis. Where appropriate she will refer you for further investigations, if the diagnosis is not clear, or not sufficiently clear. Together you will discuss whether observation or surgical removal is the right option for you.
Frequently Asked Questions
What are finger and hand ganglion cysts?
Cysts that generally develop from a joint, but sometimes from a flexor tendon sheath, in the finger or hand. They may or may not be able to be felt or seen, and can cause symptoms or be found incidentally on imaging.
What causes it?
As with wrist ganglions, the exact trigger is often unclear and many appear without any obvious cause. They are more common in middle-aged adults and in women.
What can I do myself?
Observation is reasonable if the lump isn’t bothersome. It’s worth being assessed if you have a tender lump in the palm at the base of a finger, especially if it’s affecting your grip.
What can a hand therapist do?
Finger and hand ganglion cysts are not typically managed by a hand therapist, though a hand therapist can support your recovery with therapy if you have surgery.
What can a hand surgeon do?
Confirm the diagnosis on examination, sometimes with an ultrasound if the lump isn’t clearly a ganglion. Aspiration under ultrasound guidance can be attempted but is often technically difficult and the lump frequently returns. Surgical excision, removing the cyst from its origin, is a small and effective procedure generally recommended for lumps that are persistent, tender or bothersome.
What can I expect from treatment?
A cyst that isn’t bothersome can simply be watched. Surgical excision is a well-established option for persistent or tender cysts, with the precise location determining the dressing, post-operative restrictions and likelihood of recurrence.
What happens if it's left untreated?
The cyst can remain tender with gripping, and occasionally presses on a nearby nerve causing numbness, tingling or pain, which is worth having assessed.
Related conditions and treatments
A larger, softer cyst that forms at the wrist rather than in the palm is usually a wrist ganglion cyst, which arises differently and is treated with a different procedure. A cyst near the end joint of a finger, linked to arthritis, is a digital mucous cyst. Cysts can also be similar to or clinically indistinguishable from tumours of the hand and fingers.