Ganglions and other lumps in fingers, hands & wrists

Ganglion Cyst and other lumps

The most common lumps in the hand, fingers and wrist are ganglions. The four common locations are the back or front of the wrist (dorsal or volar ganglions); the top of the end joint in the fingers (mucous cyst); and, the palm side at the base of the finger (flexor tendon sheath ganglion). 

If the lump is not any one of these 4 locations, Mr Miranda may do additional investigations such as xrays, ultrasound scan or MRI scan to make the diagnosis. These lumps, if they are not ganglions, may arise from the other tissues within the hand such as bone, tendon, muscle, nerve or blood vessels. The majority of such lumps are not harmful, but it is best to consult with your doctor about these lumps and they may decide to refer you to a Hand Surgeon. 

What are ganglion cysts?

Ganglion cyst is a small swelling that contains a thick clear liquid (synovial fluid), this surrounds your joints and also some tendons which acts as a lubricate to cushion the joint whilst moving. It looks and feels like a smooth lump under the skin. 

What is the cause?

Trauma may cause a Ganglion cyst. In most cases the cause is unknown. 

What are the symptoms?

In many cases Ganglion cysts come without any symptoms and do not cause any pain, although this may not always be the case and can cause acute pain if caused by trauma. 

Such as:

• Aching sensation made worse by joint motion.
• Swelling to the affected area.

Treatment

Non-surgical treatment

Cases of Ganglion cysts that are without any symptoms may not require treatment and may spontaneously disappear.

Aspiration which means placing a needle into the cyst and drawing the liquid the out. Some doctors inject substances into the ganglion, but this is not Mr Miranda’s preference as the evidence is lacking that these injected substances have any lasting benefit. 

Surgical treatment

An individual who suffers significant pain may require surgical removal of a ganglion cyst under regional or general anaesthetic. This would be needed especially when it affects function. The root of the wrist ganglion is deep and usually originates from the wrist joint. The root of the ganglion must be found and removed to reduce the risk of recurrence of the ganglion. 

Ganglions in the fingers are usually removed under local anaesthetic. 

Despite the best operation, there is a risk of recurrence of the ganglion of around 15% (1 in 7 chance). Other risks include scar pain and tenderness,  joint stiffness, nerve or tendon injury.