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Cubital Tunnel Syndrome

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Ganglion Cyst
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Basal Joint Arthritis of the Thumb

Ganglion Cyst


A ganglion is a fluid-filled cyst that can be found in many different locations throughout the arms or legs. It is most commonly found at the wrist or hand, and is the single most common tumor in the hand. Ganglions are always benign, with no chance of turning into a different type of tumor, or into a malignant tumor. There is no specific cause for these tumors, and studies have shown them to not be related to lifting or repetitive motion.

Back of Wrist
Ganglion Cyst The most common location for a ganglion is on the back, or "dorsum" of the wrist. It most often originates from a ligament in the wrist joint called the scapholunate ligament. The ganglion may be very small and deep, or very large and prominent against the skin. The size may fluctuate, and ganglions are known to disappear and reappear at varying intervals without known cause. They can rupture after injury. If a ganglion disappears, it occasionally will not return. Some ganglions seem to cause pain and tenderness with activity, while others do not.

Ganglion Cyst on Wrist Front Palm Side of Wrist
The second most common location for a ganglion is on the front, or palm side, of the wrist. In this location, the ganglion usually originates from the scaphotrapezial ligament deep in the wrist joint. It will lie adjacent and often adherent to the radial artery.

Base of Nail
A special type of ganglion occurs at the base of the nail on the the back of the thumb or a finger. This ganglion is also called a mucous cyst. It originates from the last joint of the digit, and is almost always associated with an arthritic spur from that joint. It may drain intermittently, and it can cause a deformity in the nail. Treatment needs to include removal of the arthritic spur.

Ganglion Cyst on Finger Base of Finger
Ganglions also commonly occur at the junction of the palm and digits. In this location, they originate from a tendon sheath instead of a ligament. These ganglions are usually tender and painful, because of the pressure placed on them with gripping and grasping activities.


  • Observation
    Ganglions are always benign, and may not be painful or tender. Not doing anything to the ganglion does not preclude other treatment options from being performed at a later date.

  • Aspiration
    This procedure is done in the office under local anesthesia. The risks of this technique are small (a small risk of infection), but the success rate is also small. Most of the time, the ganglion will only decrease in size or will recur later. Ganglions from the tendon sheath respond best to needle aspiration, and many times may not come back. Aspiration of ganglions originating from a joint (at the wrist or by the nail) is usually not successful. This technique is a safer treatment method than hitting the ganglion with a book. That old recommendation is no more successful than aspiration, is more painful, and can cause other injuries.

  • Surgical Excision
    Surgery will remove the ganglion completely, but the main risk is a new ganglion occurring from the same location at a later date. Studies reveal new ganglions can occur after surgery from 5 - 15% of the time. This rate is not dependent on activity or occupation. Surgery from ganglions at the wrist level is usually done under regional or "block" type anesthesia as an outpatient surgery. Surgery for ganglions from the palm or digit are usually done under local anesthesia as an outpatient surgery.


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