Ganglion cyst

What is a ganglion cyst? 

Ganglion cyst

Ganglion cysts are fluid filled cysts that can develop around joints or tendons. They commonly occur around the wrist but can also occur in the hand or fingers. The joints and tendon sheaths in the body are coated with a lubricating fluid called synovial fluid, which allows the joints and tendons to move freely. Ganglion cysts develop when the joint or tendon sheath has a leak of synovial fluid. This fluid leaks into a small pouch creating a cyst. The cyst can manifest as a round lump within the joint or on a tendon.

Signs and symptoms of ganglion cysts

The main sign of a ganglion cyst is the formation of a round lump in the wrist or hand. The area can be soft or firm. The cyst may increase or decrease in size based on how much fluid is leaking or being absorbed back into the joint. Most ganglion cysts are not painful; however, the cyst may begin to ache if it is squeezed or pressure is applied.

Causes of ganglion cysts

The exact cause of ganglion cysts is unknown; however, they are most common in children 15 years of age or older. They are also seen more frequently in individuals who are born female.

Change in ganglion cyst size or level of discomfort

If repetitive movements make the cyst bigger, your child’s health-care provider may recommend resting the area. They may also recommend using anti-inflammatory medications for pain and discomfort.

Diagnosis of ganglion cysts

A plastic surgeon can usually diagnose a ganglion cyst by examining its size, location and how it feels. An ultrasound or magnetic resonance imaging (MRI) scan may be needed for diagnosis in some situations.

Treatment 

Many ganglion cysts go away on their own without medical treatment. If the ganglion cyst is not causing pain or problems with the function of the fingers, hand or wrist, your child’s surgeon may recommend waiting and watching the area to see if it improves on its own. If the ganglion cyst does not go away on its own, and it is causing problems for your child, aspiration, splinting or surgery may be completed to remove it.  

• Aspiration involves draining the fluid from the ganglion cyst with a needle, which can reduce the size. The cyst may fill with fluid again, since aspiration does not completely remove the cyst. 
  
• Splinting involves using a brace or splint to support your child’s finger, hand or wrist to keep the area still and the ganglion cyst from moving. This can prevent irritation and may help reduce swelling of the ganglion cyst. 
  
• Surgery usually takes about one to two hours, and your child can go home afterwards. To keep the joint or tendons from moving, it is likely that your child’s health-care provider will recommend resting the area for one to two weeks in a plaster cast or splint following surgery.  
  

Even after surgical removal, ganglion cysts can reoccur. The chance of recurrence of ganglion cysts in children ranges from approximately 6 to 35 percent. 

Do not try to rupture or pop the cyst. If your child falls or experiences trauma to the area, the cyst may become red, swollen and sore for a few days before reducing in size or resolving.

Caring for your child with a ganglion cyst

While your child is waiting to see a plastic surgeon, you may encourage them to rest the area if it is causing them pain. You may also provide over-the-counter pain medication such as ibuprofen or acetaminophen. 

When to see a health-care provider

If the area is becoming very painful or impacting your child’s ability to move their hand, wrist or fingers, you should make an appointment to see your child’s health-care provider.  

Urgent assessment is suggested if your child experiences a loss of sensation (can’t feel their hand) or a loss of movement in the hand, fingers or wrist.  

At SickKids

Treatment age 

The Plastic Surgery Clinic at SickKids treats children with ganglion cysts up to 12 years of age. Congenital hand surgeons at the Plastic Surgery Clinic do not treat children over 12 years of age, as those children do not require specialized paediatric care. Surgery for ganglion cysts in children over 12 years of age may be performed by community hand surgeons who treat adults. There may be special circumstances, such as the following, which allow us to make individualized exceptions:

• your child has a medical complexity and is already being treated at SickKids
  
• your child has a rare form of ganglion cyst(s) that track along nerves, causing functionality issue (e.g., foot drop)
  
• your child has multiple recurrent ganglion cysts and is being referred for a second opinion by a community hand surgeon
  

Clinic appointments

The Plastic Surgery Clinic will contact you for an initial consultation to assess your child’s ganglion cyst.

References

Meyerson J, Pan YL, Spaeth M, Pearson G. Pediatric Ganglion Cysts: A Retrospective Review. Hand (N Y). 2019 Jul;14(4):445-448. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/29310457/.