Comprehensive Ganglion Cyst Treatment at Nebraska Hand & Shoulder Institute, P.C.

Nebraska Hand & Shoulder Institute, P.C. specializes in the treatment of ganglion cysts, a common non-cancerous lump that often develops in the hand and wrist. This soft tissue swelling, filled with a jelly-like substance, represents between 50% and 70% of all hand and wrist lumps. While these cysts are typically painless, they might experience rapid growth or exert pressure on nearby nerves, causing discomfort.

Sometimes, smaller, non-painful ganglion cysts do not necessitate treatment. However, when a cyst becomes large, painful, or positioned on the wrist, surgical intervention could be the most effective solution. 

Interested in learning more about our ganglion cyst treatment services or scheduling an evaluation? Contact us today.

A diagram of where a cyst can take place in the wrist

Diagram of a wrist ganglion cyst (as seen from the side with the wrist turned palm upwards)

Understanding the Ganglion Cyst

Ganglion cysts, whilst typically solitary, can appear anywhere in the hand and wrist. Most commonly seen on the top of the wrist, along the thumb side, and on the finger's distal interphalangeal joints, ganglion cysts can affect individuals of any age but are most prevalent among individuals aged between 10 and 40. They are also more likely to appear in women than in men, with no identifiable occupational or racial predisposition.

A Ganlia Cyst forming a large bulge near the wrist

Ganglion Cyst Causes and Symptoms

Ganglia develop from the connective tissue by liquefaction (decay) of collagen fibers, increasing the amount of fluid. Though many of the ganglia arise directly adjacent to a joint, they appear to be connected by a one-way valve mechanism allowing fluid from the joint to exit into the sac.

Ganglia may arise adjacent to a joint or tendon sheath and may be connected by a long stalk. Thus, their superficial appearance may not accurately represent the site of origin. Ganglia arising in response to degenerative arthritis of the interphalangeal joint are called mucous cysts and frequently result in deformity of the fingernail. If they go untreated and rupture, they may become infected. Ganglia cysts commonly occur in association with arthritis related to production of inflammatory fluid.

An MRI of a Advanced Degenerative Arthritis

Advanced degenerative arthritis at the end joint of the finger (DIP joint) frequently results in a cyst known as a mucous cyst and may cause significant nail deformity.

Cyst caused by arthritis

Cyst caused by arthritis


Cyst at nail fold that has popped

Deep Trough in Nail

Pressure from a cyst just above the nail fold has caused a deep trough in the nail. Removal of the cyst will allow the nail to grow back normally in about 4 months.



A wrist ganglion may produce pain and associated weakness, or present as a painless lump. Wrist ganglia may occur in association with ligamentous instability about the wrist. However, that is not a common finding. Ganglia may be noticed suddenly with or without pain. The majority probably develop slowly over a period of months. Spontaneous disappearance of ganglia has been reported in up to 58% of patients in some series.

Ganglion Cyst Diagnosis and Treatment Options

Due to its classic location, size, and symptoms, physical examination is usually sufficient to diagnose a ganglion cyst. However, X-rays may be necessary to identify an underlying cause, such as arthritis, and exclude other possibilities.

Non-Operative Treatment

Non-surgical treatment options for lumps include observation, home remedies, and cortisone injections, although these may have varied success rates and recurrence risks. A person who notices a lump but does not experience pain or limitation from it has several choices. They may simply observe the lump and do nothing, hoping it resolves on its own. Another more unpredictable method is attempting to pop the lump by striking it, with the hope that it scars down and does not recur. However, this approach is not reliable. 

Surgical removal, or excisional biopsy, is another option, especially if the lump is large enough to be considered unsightly or is causing discomfort. An attempt to withdraw the jelly-like fluid from a ganglion cyst with a needle is largely unsuccessful; usually, the cyst will recur. While some physicians have reported good results from cortisone injection, in my experience, there is a high rate of recurrence post-injection. There is no strong physiological reason to believe that corticosteroids would be effective in resolving this issue.

Surgical Treatment

Ganglion cyst removal or surgery is often the best option for large, uncomfortable, or obstructive cysts. Flexor retinacular cysts, arising from the tendon pulley system and affecting grip, generally need surgical removal due to their impact on hand functionality. These cysts, especially on the ring finger, can cause discomfort exacerbated by rings pressing on the cyst and nearby nerves, demanding surgical intervention.

For mucus cysts on the finger or thumb's distal joint, effective treatment involves removing both the cyst and any bone spurs through a small incision. This minimizes scarring and maintains functionality. The semi-line incision technique ensures the scar doesn't tighten over the finger, promoting better healing. Nail deformities from cyst pressure often improve as the nail grows back after surgery.

A Mucous Cyst jetting out of the top of a patient finger

Example of a mucous cyst

Nail Deformity From Mucous Cyst

Nail deformity from a mucous cyst

Traditional Surgery (Wrist Ganglion):

Ganglion removal is best done using a small 1/2" transverse incision. The ganglion is exposed down to the joint and cut out along with a small wedge of the joint capsule.

Arthroscopic Surgery:

There is an arthroscopic technique for removing a wrist ganglion. It is straightforward and requires two small puncture wounds in the wrist. It is equally effective as open ganglion removal, but it leaves an even smaller incisional scar, and it costs a lot more due to the use of elaborate equipment.

For the person determined to absolutely minimize the size of the scar and for whom "money is no object" - there aren't many of those around - arthroscopic removal of a ganglion is a safe, straightforward outpatient procedure.

Surgical removal of ganglia, in general, is quite effective. However, in order to obtain a good result one must do the surgery in an operating room. This prevents injury to associated structures, such as the superficial nerves and arteries, and minimizes incision size. It decreases the chance of recurrence by allowing careful dissection down to the base of the ganglion and excision of the entire ganglion with its origin.

Post-Surgical Care and Rehabilitation

At Nebraska Hand & Shoulder Institute, P.C., we typically see minimal post-operative discomfort and a rare need for continued hand therapy. With an unrestricted movement approach, we encourage patients to get moving immediately to avoid stiffness. Our comprehensive ganglion cyst removal procedure offers an 85-90% chance of permanent cure. 

Let us help you eliminate the worry of an undiagnosed condition and provide you with comprehensive, expert care. Contact us today to schedule your ganglion cyst evaluation.


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