Ganglions

Treatment Overview

Ganglions usually do not need treatment. Because a ganglion is not cancerous and may disappear with time, your doctor 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 doctor 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.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: September 23, 2008
Medical Review:	William M. Green, MD - Emergency Medicine David Pichora, MD, FRCSC - Orthopedic Surgery
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