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A ganglion cyst is the most common soft tissue tumor in the hand and wrist. The most common of these benign tumors is a ganglion cyst appearing on the dorsum (or back) of the wrist, just past the skin crease where the wrist bends back and forth. This cyst comes from a specific joint between two bones in the wrist called the scaphoid and lunate bones.

These cysts almost always come from joints and may start in any joint in the hand or wrist. Another one of the most common places for a cyst is the dorsum of the finger between the skin creases of the end knuckle (DIP joint) and the start of the fingernail.

Most hand surgeons believe that the majority of cysts happen after some sort of trauma to the involved joint. A small hole develops in the joint lining and allows fluid to escape - the fluid forms a cyst.

What Is a ganglion cyst?

A ganglion cyst is a very common bump or mass that usually appears near joints or tendons in the hand or wrist. Common locations include the dorsal (back side) surface of the wrist, the palm side of the wrist, the base of the palm side of the finger, and the dorsal surface of the end joint of the finger.

You can envision what a ganglion cyst looks like by picturing a balloon filled with clear jelly, attached to a hollow stalk that comes from the joint or tendon lining. Fluid travels from the joint or tendon sheath into the stalk, and fills the balloon with fluid.

Constant motion of the hand or wrist keeps fluid pumped into the cyst and it can't get back out. Ganglion cysts can be uncomfortable if they put pressure on nerves, tendons, or skin.

The good news is that they may go up and down in size or even go away completely on their own, without any needles or surgery. They may not be painful. Ganglion cysts are not malignant (they are not made up of cancer cells) and they don't spread to other areas, though they may get larger or more lobulated (more lumpy).

How is the diagnosis made?

Diagnosis is based on the patient's history (how he or she noticed the mass), where the lump is and what it feels like. Sometimes patients say they remember injuring the hand or wrist several weeks before noticing the cyst, but most patients can't remember a specific event.

Cysts are usually round and firm. You can usually feel the smooth edges of a ganglion cyst, and you can often move the cyst around under the skin with your fingers. Cysts at the base of the finger are usually firm, pea-sized bumps that hurt when gripping narrow objects, like a steering wheel or suitcase handle.

Putting a flashlight on the skin around the mass will make it "light up" in a darkened room (transillumination), indicating that the mass has clear fluid inside.

Cysts at the end of the finger (DIP joint cysts) near the fingernail may push on the growing nail, causing a groove in the nail. Sometimes these may drain if the skin above them gets too thin.

I usually get x-rays to look at the bones and joints around the cyst. Sometimes I can see some nearby arthritis that explains the source of the cyst fluid, but in young people there is rarely an obvious source of the mass on x-rays. Rarely a cyst will be a sign of a serious ligament injury that hasn't been diagnosed yet.

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