A ganglion is a smooth, firm lump filled with clear jelly like fluid that arises from a joint or a tendon sheath. They are the most common lump in the hand and wrist, they are not cancer, and a great many need no treatment at all. Where a ganglion is painful, keeps coming back, or sits at the fingertip and is deforming the nail, removing it is straightforward. The operation takes about 20 minutes as a day procedure and the dressing comes off within a few days.
What is a ganglion?
A ganglion forms where the lining of a joint or tendon sheath bulges out through a weak point and fills with the fluid that normally lubricates it. The fluid is clear and thick, closer to jelly than to water, which is why a ganglion feels firm rather than soft.
It stays connected to the joint it came from by a narrow stalk, and that stalk is the reason ganglions come back if only the lump itself is removed. Treating a ganglion properly means dealing with its origin, not just the visible part.
Ganglions change size. They swell with activity and settle with rest, they can disappear for months and return, and a proportion resolve on their own without anything being done.
Where they occur
- Back of the wrist. The most common by far, arising from the scapholunate ligament in the middle of the wrist. Often most obvious when the wrist is bent forwards.
- Front of the wrist, on the thumb side, arising from the joints beneath. These sit close to the radial artery, which matters when removing them.
- Base of the finger, on the palm side. Small, hard, the size of a dried pea, and often surprisingly tender when you grip something firm like a steering wheel or a shopping bag.
- At the fingertip, arising from the joint closest to the nail. These are called mucoid cysts and behave differently from the others, which is covered below.
VIEW A VIDEO OF OUR GANGLION CYST CONSULT
Dr Paul van Minnen (Wrist ganglion)
Dr Paul van Minnen (Mucoid cyst of the finger)
Dr Nicholas Smith (Wrist Ganglion)
Dr Nicholas Smith (Mucoid cyst of the finger)
Symptoms
Many ganglions cause nothing at all beyond their appearance. Where they do cause symptoms, people describe:
- A smooth firm lump that changes size over weeks or months
- An ache in the wrist, often worse with loaded or extreme positions such as press ups or leaning on the hand
- Tenderness on direct pressure, particularly with the small ones at the base of the finger
- Restricted movement where the ganglion is large
- Occasionally pins and needles, where a ganglion presses on a nearby nerve
A small ganglion deep in the wrist that cannot be seen or felt is called an occult ganglion, and it can cause wrist pain with no visible lump at all.
How it is diagnosed
Usually by examination. The position, the smooth firm feel, the way it transilluminates when a light is held against it, and the history of a lump that changes size are characteristic.
An ultrasound is useful where the diagnosis is uncertain, where the lump is deep or not visible, or where it sits close to an artery. An X-ray is worth having where there is a fingertip cyst or where arthritis is suspected underneath.
Most lumps in the hand are benign, and most of those are ganglions. A lump that is hard rather than firm, fixed rather than mobile, growing steadily rather than fluctuating, or painful at night deserves imaging rather than reassurance.
Treatment
Leaving it alone
A perfectly reasonable choice, and the right one for a good proportion of people. A ganglion that does not hurt and does not restrict you needs no treatment, and a meaningful number resolve on their own given time. Knowing what it is often removes the reason people wanted it gone.
Aspiration
Drawing the fluid out with a needle empties the lump immediately, and for some people that is enough. It does not deal with the stalk, so the ganglion refills in a substantial proportion of cases. We arrange aspiration under ultrasound guidance rather than doing it in the rooms, so that the needle goes where it is meant to and the structures nearby are avoided. Aspiration is not appropriate for cysts on the front of the wrist, because of the radial artery, or for mucoid cysts at the fingertip, because of the risk of introducing infection into the joint.
The one thing not to do
The old advice to hit a ganglion with a heavy book is genuinely bad advice. It works occasionally, it recurs often, and it risks injuring the structures underneath. Nothing about a ganglion justifies it.
Surgical excision
Removing the ganglion together with its stalk and the small piece of joint lining it arises from is what gives a durable result. It is the treatment of choice where a ganglion is painful, restricting movement, recurring after aspiration, or where the diagnosis needs confirming.
Recurrence after proper excision is uncommon but not impossible, because the joint that produced one can produce another. It happens in about 1 in 20 cases, which is the same figure as for a mucoid cyst at the fingertip.
Mucoid cysts, the ones at the fingertip
The finger joint closest to the fingernail is called the DIP joint. It is a common site for mild osteoarthritis, and that arthritis is what produces a mucoid cyst. They arise from the DIP joint and are filled with clear joint fluid.
Some sit close to the nail fold and press on the nail as it grows, which causes a lengthwise groove in the nail plate. That groove is often what brings people in, rather than the lump itself.
Mucoid cysts matter more than their size suggests. Left untreated, the cyst can cause a permanent nail plate deformity, repeatedly drain joint fluid, or cause infections. A cyst that is discharging fluid sits directly over a joint, and that is a route for infection into the joint itself. The treatment of choice is to remove the cyst completely, including its origin at the DIP joint.
The operation
The cyst is removed through a curved incision in the skin overlying the cyst and the DIP joint. The bony bumps at the origin of the cyst are removed as well, because they are what generated it. In most cases the raised skin is rotated slightly to allow the wound to be closed, which is called a local flap procedure. A tape bandage covers the wound under a soft finger dressing.
It usually takes place as a day surgery procedure using sedation and a local anaesthetic, and takes approximately 20 minutes.
Recovery after mucoid cyst excision, week by week
Indicative. Recovery after a wrist ganglion excision differs and will be explained to you separately.
Timeframe
What to expect
Day of surgery
Some of your fingers may feel numb or tingly for two to three days because of the local anaesthetic. You can start to move and use your fingers, including the operated one, for light tasks before you leave hospital.
Days 1 to 3
Keep the dressing clean and dry. On day 2 or 3 you can take the dressing off your finger, leaving the tape bandage on the skin intact.
Days 3 to 14
The tape bandage can get wet in the shower or when you wash your hand. Dab it dry afterwards. Avoid swimming and bathing the finger. If the tape separates, use a bandaid to protect the sutures. Use the hand lightly as tolerated and avoid heavy tasks.
Two weeks
Your progress is reviewed and the skin sutures are removed at this visit. If needed, a new tape bandage goes on for another three to five days. In most cases the scar or the finger is still somewhat swollen, crusty or tender at this stage, which is normal.
Two to six weeks
Wound healing takes two to three weeks. It is not abnormal for the area around the scar to remain tender, pink or swollen for four, and sometimes six, weeks after surgery. Moisturising and massage of the area help.
Six weeks
A further follow up appointment if one is needed. The fingertip around the scar will still be somewhat red or pink at this stage, and it settles on its own.
Where the nail was already grooved before surgery, the groove grows out slowly with the nail rather than correcting immediately. A fingernail takes several months to replace itself, so the improvement is measured in months.
Risks and complications
Excision of a mucoid cyst is routine and safe, and complications rarely occur. When they do they can include:
- Wound healing problems or infection.
- Bleeding or bruising. Usually minor and settles on its own.
- Ongoing tenderness or swelling around the scar, or slower than expected recovery.
- Nail deformity. The existing nail deformity may not improve, or a new one may develop after the surgery.
- Recurrence. In approximately 1 in 20 cases the DIP joint produces another mucoid cyst, which may require another procedure.
For ganglions elsewhere in the hand and wrist the risks differ with the site. A ganglion on the front of the wrist sits against the radial artery, and one at the base of the finger sits between the small nerves to the finger. These are discussed with you before surgery for the specific ganglion you have.
When to be seen sooner
Contact us, or see your GP, if you have:
- A lump that is hard rather than firm, or fixed rather than mobile
- A lump growing steadily rather than fluctuating in size
- Pain that wakes you at night
- A fingertip cyst that is discharging fluid, which is a route for infection into the joint
- Redness, spreading pain or fever around any cyst
- Numbness or weakness in the hand alongside the lump
A discharging mucoid cyst is the one on this list that should not wait. If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Is a ganglion cancer?
No. A ganglion is a fluid filled swelling arising from a joint or tendon sheath. It is the most common lump in the hand and it is benign. Lumps that are hard, fixed or steadily growing are a different matter and are worth imaging.
Will it go away on its own?
It might. A meaningful proportion of ganglions resolve without treatment, and many that persist cause no trouble. If it does not hurt and does not restrict you, leaving it alone is a legitimate choice rather than a failure to act.
Can you just drain it with a needle?
The fluid can be drawn out and the lump disappears immediately, but the stalk connecting it to the joint remains and a substantial proportion refill. Where aspiration is worth trying we arrange it under ultrasound guidance rather than doing it in the rooms. It is not suitable for cysts on the front of the wrist, because of the radial artery, or for fingertip cysts, because of the risk of introducing infection into the joint.
Why does the cyst on my fingertip affect my nail?
Because it sits directly over the area where the nail is formed and presses on it as the nail grows, producing a lengthwise groove. Removing the cyst takes the pressure off, but the groove grows out with the nail over several months rather than correcting straight away.
How long does the operation take, and will I be awake?
A mucoid cyst excision takes approximately 20 minutes as a day surgery procedure using sedation with a local anaesthetic. You go home the same day. Wrist ganglion surgery takes longer and is planned individually.
Will it come back?
For mucoid cysts, in approximately 1 in 20 cases the joint produces another one. For ganglions elsewhere, recurrence is uncommon after the stalk and the joint lining it arises from are removed, which is why excision is more durable than aspiration.
Should I have it removed just because I do not like the look of it?
That is a reasonable reason and plenty of people choose it, but it is worth weighing against a scar and a recovery period. What is not reasonable is being talked into surgery for a lump that is not bothering you.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 10 September 2026