Dr. Jonathan Mulford, Orthopaedic Surgeon, NSW Australia Total Knee Replacement, NSW Australia
Sports Knee Ligament Reconstruction, NSW Australia
Knee Arthroscopy, NSW Australia


Reproduced with permission from Dr Stuart Myers at www.myhand.com.au

Ganglion Cysts are very common swellings (lumps) that sometimes grow in the hand and wrist.

These cysts are NOT malignant (cancerous).

Ganglions in the hand occur in 4 characteristic sites:

  1. Dorsal wrist - The back of the wrist
  2. Volar wrist - Palm / thumb side of the wrist
  3. Mucous cyst - The end joint of a finger associated with arthritis & may cause finger nail deformity or ridging
  4. Flexor sheath ganglion - Base of a finger arising from the sheath around the tendons
Dorsal wrist Volar wrist Mucous cyst Flexor sheath ganglion
Dorsal Wrist, NSW Australia Volar Wrist, NSW Australia Mucous Cyst, NSW Australia Flexor Sheath Ganglion, NSW Australia

Ganglion cysts usually arise from adjacent joint linings or tendon sheaths.

Although there is usually no specific cause for ganglions, there may have been an injury before the appearance of a cyst.

These cysts can be painful, especially when they first appear and with constant or strenuous use of the hand. Ganglions may fluctuate in size and may disappear spontaneously.

Knee Cap (Patella) Instability, NSW Australia Non-Operative Knee Osteoarthritis Treatment, NSW Australia Viscosupplementation for Knee Arthritis, NSW Australia


The diagnosis of a ganglion cyst is usually based on where the cyst is and what it looks like. Dr Mulford may recommend x-rays to rule out problems in nearby joints or extension of the ganglion into the bone. An ultrasound may confirm the diagnosis when a ganglion is very small. Often no tests are required.


  1. Observation - Some ganglions resolve spontaneously
  2. Hit it with a Bible! (not recommended)
  3. Injection with cortisone & bursting or draining the ganglion. Not very effective for wrist ganglions but is of use particularly for flexor sheath ganglions
  4. Wrist brace (OAPL) - Obtained from my secretary
  5. Surgery - Indicated if the cyst is painful, limits activity, or its appearance is unacceptable & other treatments have failed- Aim to remove not only the cyst but also the stalk & a small flap of the capsule or ligament from which the ganglion is arising- Is generally performed in hospital as a day only procedure

Surgery for Ganglions

1. Dorsal wrist:

After the operation the wrist is in a splint for a few days & then the wrist can be exercised - often bending the wrist forward is limited for a few months following the surgery but usually returns with time- the major problem with this surgery is that approximately 10% of ganglions recur following resection.

2. Volar Wrist:

  • Issues are similar to dorsal ganglions but in addition
  • The Radial artery often runs over the ganglion & must be carefully preserved
  • A small nerve branch to the base of thumb region is very close to the scar & can be irritated with this surgery - Scar massage after the operation may be required

3. Mucous cysts:

  • The DIP or end joint of a finger is commonly affected by osteoarthritis. The ganglion or cyst forms secondary to the arthritis
  • May cause finger nail deformity or ridging due to pressure on the nail bed
  • Excision of mucous cysts requires not only excision of the cyst & stalk but also the entire back capsule of the DIP joint & any loose pieces of bone or spurs on the back of the joint
  • Recurrence rate also ~ 10%
Knee Replacement Surgery, NSW Australia
Sydney Orthopaedic Surgeon, NSW Australia

I am a orthopaedic surgeon that specialises in all aspects of Hip and Knee surgery...

Meet Dr. Jonathan Mulford
Trauma Surgery, NSW Australia
Dr Mulford was awarded a Diploma in Clinical Trials from the University of London in 2008.
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