Ganglion cyst: causes, treatment and when to see a GP

The NHS says most ganglion cysts do not usually need to be treated or removed. BSSH says they are harmless and can safely be left alone, many disappear spontaneously and many others cause little trouble.

If a cyst is causing problems, the NHS says it can be treated by draining the cyst using a needle (aspiration), a steroid injection to reduce swelling, or cutting the cyst out with a small surgical operation. Once a cyst is removed it usually does not return, but sometimes it can come back.

BSSH sets out three broad possibilities: explanation, reassurance and waiting to see if the cyst disappears spontaneously; removal of the liquid contents with a needle under local anaesthetic; or surgical removal. The recommendation for any individual cyst depends on its location and the symptoms it causes.

The NHS says that if a ganglion cyst hurts when you use your hand, there are things you can do to treat it yourself. A pharmacist can recommend medicines to help with any pain and advise on how to use wrist supports or compression wraps.

• Take ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce swelling and pain, if they are suitable for you.

• Try wrist supports or compression wraps (a stretchy elastic bandage), which you can buy from supermarkets or pharmacies.

• Do not try to burst or pop the cyst, because this could cause an infection or skin damage.

• Be patient: the NHS says getting better without treatment can take from several months up to a year.

The NHS says the cause of ganglion cysts is not always known, but they sometimes happen after an injury causes fluid to leak from a joint. They are much more common in women than in men. BSSH says most ganglion cysts arise spontaneously but occasionally there is a history of injury or the joint is starting to develop arthritis.

BSSH says ganglion cysts contain a thick, clear fluid and can arise from a variety of structures, such as a wrist ligament, the wrist joint, a tendon sheath or the end joint of a finger.

BSSH says ganglion cysts are the commonest type of swelling in the hand and wrist. The NHS describes them as smooth, soft lumps under the skin that are usually on the hands or wrists near a joint, but can be on the top of the foot, and vary in size from smaller than a pea to a few centimetres across.

They are usually painless but can be painful during or after moving the affected joint. The lump may be your only symptom, but you may also have numbness or aching after moving the joint. BSSH says the diagnosis is usually straightforward as the cysts tend to be smooth and round, fluctuate in size and occur at characteristic locations; scans may be helpful if the diagnosis is uncertain.

The NHS says to see a GP if you are worried about a lump, a lump gets bigger, or a lump is hard and does not move.

Ask for an urgent GP appointment or get help from NHS 111 if you have a lump that is very painful, hot or red. Redness may be harder to see on brown and black skin.

The NHS says that once a cyst is removed it usually does not return, but sometimes it can come back. BSSH gives recurrence figures by type: aspiration often leads to the swelling returning for dorsal wrist cysts, and the risk of recurrence after surgery is around 10% for dorsal wrist and dorsal digital cysts and around 30% for palmar wrist cysts.

Surgery also has risks. For wrist cysts BSSH lists persistent pain, loss of wrist movement and painful trapping of nerve branches in the scar, which is why many surgeons advise against operating on palmar wrist ganglia.

On the NHS, a pharmacist can advise on pain relief and wrist supports, and a GP can assess a lump that worries you, grows, or is hard and fixed, and discuss aspiration, injection or referral for surgery. Because most cysts need no treatment, referral is usually for cysts that are painful or limit hand use.

Some people choose a private hand surgeon for faster assessment or ultrasound. It is worth asking about the chance of recurrence for the type of cyst you have, since BSSH gives different figures for different locations.