Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Ganglion cysts of the wrist and hand

Filip De Keyser, MD, PhD
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


A ganglion cyst is one of the most common soft tissue swellings in the hand and wrist. Although ganglion cysts are benign lesions, they may lead to pain, weakness, and loss of function, and sometimes require treatment.

The presentation, diagnosis, differential diagnosis, and treatment of ganglion cysts of the wrist and hand will be discussed here. The evaluation of the adult with hand or wrist pain are discussed separately. (See "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "History and examination of the adult with hand pain".)


A ganglion cyst is a fluid-filled swelling overlying a joint or tendon sheath. Ganglion cysts are thought to arise from a herniation of dense connective tissue from tendon sheaths, ligaments, joint capsules, bursae, and menisci. They contain a mucinous, gelatinous fluid.

The most common location for ganglion cysts is the dorsal side of the wrist (70 percent) (picture 1) [1]. Most of the dorsal wrist ganglions can be traced by their stalk as originating from the radiolunate ligament [2]. The cysts can be unilocular or multilocular. The second most common location for ganglion cysts in the hand is the volar side of the wrist (20 percent) over the scaphotrapezoid joint. Ganglions can also arise from the digital flexor tendon sheath, which has classically been described as arising from the first annular (A1) pulley (figure 1) of the fingers. A small mass may be palpable in the flexion crease at the base of the finger.

A digital mucous (or mucinous) cyst is a ganglion cyst that forms over the dorsal side of the distal interphalangeal (DIP) joint (picture 2) [3]. They occur most commonly in the fifth to seventh decades and are usually associated with an underlying diagnosis of osteoarthritis.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Dyer SM, Simmons BP. The wrist and hand. In: Rheumatology, 6, Hochberg MC, Silman AJ, Smolem JS, et al (Eds), Mosby, St.Louis 2015. Vol 1, p.624.
  2. Lowden CM, Attiah M, Garvin G, et al. The prevalence of wrist ganglia in an asymptomatic population: magnetic resonance evaluation. J Hand Surg Br 2005; 30:302.
  3. Salerni G, González R, Alonso C. Dermatoscopic pattern of digital mucous cyst: report of three cases. Dermatol Pract Concept 2014; 4:65.
  4. Steiner E, Steinbach LS, Schnarkowski P, et al. Ganglia and cysts around joints. Radiol Clin North Am 1996; 34:395.
  5. McCarthy CL, McNally EG. The MRI appearance of cystic lesions around the knee. Skeletal Radiol 2004; 33:187.
  6. Giard MC, Pineda C. Ganglion cyst versus synovial cyst? Ultrasound characteristics through a review of the literature. Rheumatol Int 2015; 35:597.
  7. Parekh NN, Desai NS, Ricci JA. Ganglion cyst causing finger dysesthesias. Am J Phys Med Rehabil 2015; 94:254.
  8. Westbrook AP, Stephen AB, Oni J, Davis TR. Ganglia: the patient's perception. J Hand Surg Br 2000; 25:566.
  9. Teefey SA, Dahiya N, Middleton WD, et al. Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol 2008; 191:716.
  10. Vo P, Wright T, Hayden F, et al. Evaluating dorsal wrist pain: MRI diagnosis of occult dorsal wrist ganglion. J Hand Surg Am 1995; 20:667.
  11. Robertson PL, Page PJ, McColl GJ. Inflammatory arthritis-like and other MR findings in wrists of asymptomatic subjects. Skeletal Radiol 2006; 35:754.
  12. Crosby SN, Alamanda VK, Weikert DR, Holt GE. Avoiding unplanned resections of wrist sarcomas: an algorithm for evaluating dorsal wrist masses. Am J Orthop (Belle Mead NJ) 2013; 42:401.
  13. Hsu CS, Hentz VR, Yao J. Tumours of the hand. Lancet Oncol 2007; 8:157.
  14. El Beaino M, Araujo DM, Lazar AJ, Lin PP. Synovial Sarcoma: Advances in Diagnosis and Treatment Identification of New Biologic Targets to Improve Multimodal Therapy. Ann Surg Oncol 2017; 24:2145.
  15. Suen M, Fung B, Lung CP. Treatment of ganglion cysts. ISRN Orthop 2013; 2013:940615.
  16. Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol 2007; 32:502.
  17. Nield DV, Evans DM. Aspiration of ganglia. J Hand Surg Br 1986; 11:264.
  18. Zubowicz VN, Ishii CH. Management of ganglion cysts of the hand by simple aspiration. J Hand Surg Am 1987; 12:618.
  19. Stephen AB, Lyons AR, Davis TR. A prospective study of two conservative treatments for ganglia of the wrist. J Hand Surg Br 1999; 24:104.
  20. Korman J, Pearl R, Hentz VR. Efficacy of immobilization following aspiration of carpal and digital ganglions. J Hand Surg Am 1992; 17:1097.
  21. Varley GW, Needoff M, Davis TR, Clay NR. Conservative management of wrist ganglia. Aspiration versus steroid infiltration. J Hand Surg Br 1997; 22:636.
  22. Jagers Op Akkerhuis M, Van Der Heijden M, Brink PR. Hyaluronidase versus surgical excision of ganglia: a prospective, randomized clinical trial. J Hand Surg Br 2002; 27:256.
  23. Paul AS, Sochart DH. Improving the results of ganglion aspiration by the use of hyaluronidase. J Hand Surg Br 1997; 22:219.
  24. Kang L, Akelman E, Weiss AP. Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg Am 2008; 33:471.
  25. Bontempo NA, Weiss AP. Arthroscopic excision of ganglion cysts. Hand Clin 2014; 30:71.