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# Ganglion cyst

A ganglion cyst is a harmless fluid-filled lump from a joint or tendon sheath, most often on the back of the wrist; it is the most common hand lump.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Wrist capsule](https://durgical.com/en/anatomy/wrist-joint-capsule/)
- [Scapholunate ligament](https://durgical.com/en/anatomy/scapholunate-interosseous-ligament/)
- [Dorsal radiocarpal ligament](https://durgical.com/en/anatomy/dorsal-radiocarpal-ligament/)
- [Extensor tendon sheaths](https://durgical.com/en/anatomy/wrist-extensor-tendon-sheaths/)
- [Flexor tendon sheaths](https://durgical.com/en/anatomy/flexor-tendon-synovial-sheaths/)
- [Radial artery](https://durgical.com/en/anatomy/radial-artery/)
- [Scaphoid](https://durgical.com/en/anatomy/scaphoid/)
- [Lunate](https://durgical.com/en/anatomy/lunate/)

## Why it happens

- [Hyaluronic acid (hyaluronan)](https://durgical.com/en/biochemistry/molecules/hyaluronic-acid/)
- [Synovial joints: capsule, synovial membrane and articular cartilage](https://durgical.com/en/histology/synovial-joints-capsule-synovial-membrane-and-articular-cartilage/)

## What it is

A benign, fluid-filled swelling arising from a [joint capsule](https://durgical.com/en/anatomy/articular-capsule-of-knee-joint/) or tendon sheath, most often on the back of the wrist. It is the most common soft-tissue mass of the hand and wrist.

## Who gets it

Most common in women and in people between their 20s and 40s. It is a frequent reason for consultation in hand and general orthopaedic clinics.

## Causes

- Usually no clear cause
- Mucoid degeneration of the joint capsule or tendon sheath
- Previous minor trauma or repetitive stress in some cases
- Underlying joint degeneration (mucous cysts at the finger DIP joints with osteoarthritis)

## Risk factors

- Female sex
- Age 20 to 40
- Repetitive wrist loading (gymnasts, manual work)
- Osteoarthritis of the finger joints (mucous cysts)

## Pathophysiology

A one-way valve from the joint or sheath lets synovial fluid collect in a sac without a true epithelial lining, where it thickens into a gel-like mucin. About two-thirds are dorsal and arise from the [scapholunate ligament](https://durgical.com/en/anatomy/scapholunate-interosseous-ligament/) area; volar wrist ganglia usually arise near the radial artery from the radiocarpal or scaphotrapezial joint.

## Classification

- Dorsal wrist ganglion (most common)
- Volar wrist ganglion
- Flexor tendon sheath (retinacular) ganglion at the base of a finger
- Mucous cyst at the distal interphalangeal joint
- Occult ganglion (not palpable)

## Symptoms and signs

- Round, smooth, firm or rubbery lump that may change size
- Often painless; sometimes aching or weakness with gripping
- Pain with wrist extension, especially with small occult dorsal ganglia
- Tingling if it presses on a nearby nerve

## Red flags

- Rapid growth, hard fixed mass or irregular shape (other tumour)
- Redness, heat or fever (infection)
- Numbness or weakness in a nerve territory (compression, e.g. Guyon canal or [carpal tunnel](https://durgical.com/en/anatomy/carpal-tunnel/))

## Diagnosis

**Clinical**
Smooth, mobile, well-defined lump at a typical site. It transilluminates: a light shone through it shows a glow, unlike a solid mass. Clinicians check the nearby [radial artery](https://durgical.com/en/anatomy/radial-artery/) (Allen test for volar ganglia) and nerves.

**Tests**
Aspiration yields thick, clear, jelly-like fluid, which supports the diagnosis.

**Imaging**
Ultrasound confirms a cystic lesion and its stalk; X-ray looks for arthritis; MRI for occult ganglia or uncertain masses.

## Differential diagnosis

- Lipoma
- Giant cell tumour of tendon sheath
- Tenosynovitis or rheumatoid nodule
- Carpal boss (bony bump at the base of the second and third metacarpals)
- Vascular lesion such as a radial artery aneurysm (volar)

## Goal of treatment

Confirm the benign nature of the lump, relieve symptoms and reduce recurrence when treatment is needed.

## Treatment

**Follow-up**
Observation for painless ganglia: many resolve on their own, and reassurance is often all that is needed.

**Procedure**
Needle aspiration, sometimes with corticosteroid injection; simple and quick but recurrence is common. Caution near the radial artery with volar ganglia.

**Surgical**
Surgical excision (open or arthroscopic) including the stalk and part of the capsule, for painful, recurrent or troublesome cysts; recurrence is lower than with aspiration but not zero.

## Complications

- Recurrence after aspiration or surgery
- Wrist stiffness or scar pain after surgery
- Injury to the radial artery or nearby nerves (volar excision)
- Infection (rare)

## Prognosis

Benign, with no malignant potential. Many disappear without treatment; recurrence after aspiration is common and lower after excision.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common location of a wrist ganglion and from which ligament does it usually arise?

The dorsal wrist, usually from the scapholunate ligament region.

## Which simple bedside test helps tell a ganglion from a solid mass?

Transillumination: a light shone through a ganglion makes it glow because it is fluid-filled.

## Which artery must be considered before aspirating a volar wrist ganglion?

The radial artery, which often lies very close to volar ganglia.

## Does a ganglion cyst have a true epithelial lining?

No. Its wall is compressed connective tissue without a true synovial or epithelial lining, which is why it is not a true cyst.

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## Related conditions

- [De Quervain tenosynovitis](https://durgical.com/en/conditions/de-quervain-tenosynovitis/)
- [Carpal tunnel syndrome](https://durgical.com/en/conditions/carpal-tunnel-syndrome/)
- [Trigger finger](https://durgical.com/en/conditions/trigger-finger/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Ganglion Cyst](https://www.ncbi.nlm.nih.gov/books/NBK470168/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/ganglion-cyst/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/ganglion-cyst/