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Wrist ganglion
Understanding wrist ganglion cysts, the most common lump found at the wrist, and how they are assessed and managed.
At a glance
What is it?
A fluid-filled sac that arises from a wrist joint or nearby tendon sheath
Common symptoms
A lump on the back or palm side of the wrist that may change size, with or without aching
Who it affects
Most common in young to middle-aged adults, and more common in women
Is it serious?
Not dangerous and benign, but a palm-side ganglion sits close to the radial artery and needs careful assessment
Treatment options
Observation, aspiration, or surgery
First step
A consultation and examination, often with ultrasound, to confirm the diagnosis and its exact location
What is it?
A wrist ganglion cyst is a fluid-filled sac that arises from the lining of a wrist joint or a nearby tendon sheath, filled with a thick, jelly-like fluid. It is the most common lump found at the wrist. The most frequent location is the back of the wrist (a dorsal wrist ganglion), usually connected to the scapholunate ligament. The second most common location is the palm side of the wrist (a volar wrist ganglion), which sits close to the radial artery.
Causes and risk factors
- Arising from the lining of a nearby wrist joint or tendon sheath
- Can follow a minor injury or repetitive strain
- Can be associated with osteoarthritis of the wrist joints
- Most common in young to middle-aged adults
- More common in women
The exact trigger for a wrist ganglion is often unclear, and many appear without any obvious cause.
Symptoms and how it presents
The main feature is a lump on the back or palm side of the wrist that may be soft or firm, and can change in size over time, sometimes appearing and disappearing altogether. It can be painless, or ache with activity, particularly bending the wrist back or weight-bearing through the hand. Occasionally a wrist ganglion presses on a nearby nerve and causes tingling.
How is it diagnosed?
A wrist ganglion is usually diagnosed on examination. An ultrasound is often used to confirm the diagnosis, particularly if the ganglion is difficult to feel or not possible to feel, because it is quite small. It is important to confirm the diagnosis before any treatment is planned.
Treatment options
Many wrist ganglion cysts can simply be observed, as a good proportion come and go or resolve on their own over time without any treatment.
Aspiration, draining the fluid with a needle, is an option, but the cyst is prone to returning because the underlying connection to the joint or tendon sheath is not removed. Your GP or Dr Tomlinson can refer you to a radiologist to have the ganglion aspirated under ultrasound guidance.
Surgical excision offers a more durable option, removing the cyst along with its connection to the joint or tendon sheath. This is generally recommended if the cyst is large, painful, affecting function, or has returned after aspiration.
When to see a hand surgeon
It is worth being assessed if a wrist lump is enlarging, painful, affecting movement of your wrist, or causing tingling.
What to expect at your appointment
At your appointment, Dr Tomlinson will examine the lump and any imaging you have had. If there is uncertainty about the diagnosis she may refer you for further imaging. Together you will discuss whether observation, aspiration, further investigations or surgery is the right option for you.
Frequently Asked Questions
What is a wrist ganglion?
A fluid-filled sac that arises from the lining of a wrist joint or a nearby tendon sheath, filled with a thick, jelly-like fluid. It’s the most common lump found at the wrist, most often on the back of the wrist, and sometimes on the palm side.
What causes it?
The exact trigger is often unclear. A ganglion can follow a minor injury or repetitive strain, and can be associated with osteoarthritis of the wrist joints, but many appear without any obvious cause.
What can I do myself?
Many wrist ganglion cysts can simply be observed, as a good proportion come and go or resolve on their own over time without any treatment. It’s worth being assessed if a lump is enlarging, painful, affecting wrist movement, or causing tingling.
What can a hand therapist do?
Hand therapy isn’t typically the primary treatment for a wrist ganglion itself, but a hand therapist supports your recovery with therapy if you have surgery.
What can a hand surgeon do?
Confirm the diagnosis on examination, often with ultrasound to check its exact location. Options include aspiration, draining the fluid with a needle under ultrasound guidance, though the cyst is prone to returning, or surgical excision, which removes the cyst along with its connection to the joint or tendon sheath and offers a more durable option. Surgery is generally recommended if the cyst is large, painful, affecting function, or has returned after aspiration.
What can I expect from treatment?
Many ganglions settle with observation alone. Aspiration can reduce a cyst but recurrence is common since the underlying connection isn’t removed. Surgical excision is a well-established day procedure aimed at removing the cyst more durably.
What happens if it's left untreated?
Many wrist ganglions are harmless and some resolve on their own, but they can persist, enlarge, or continue to ache with activity. Occasionally a ganglion presses on a nearby nerve and causes tingling, which is worth having assessed.
Related conditions and treatments
A smaller, firmer cyst that forms in the palm at the base of a finger, rather than at the wrist, is usually a finger and hand ganglion cyst, which arises differently and is treated with a different procedure. A cyst near the end joint of a finger is a digital mucous cyst.