Ganglion of the Wrist and Hand

Definition

Mucin-filled cyst arising from an adjacent joint capsule or tendon sheath and joined to it by a stalk. The wall has no true synovial lining.

Pathology

  • Mucoid degeneration of capsular or tendon sheath connective tissue
  • Wall of compressed collagen without an epithelial or synovial lining
  • Thick clear fluid rich in hyaluronic acid

Epidemiology

  • Most common soft tissue mass of the hand and wrist
  • Women more often, in the second to fourth decades

Classification

  • Dorsal wrist. 60 to 70%, arising from the scapholunate ligament
  • Volar wrist. About 20%, from the radiocarpal or scaphotrapezial joint, beside the radial artery
  • Flexor tendon sheath. Firm seed ganglion at the A1 or A2 pulley
  • Mucous cyst. Dorsal DIP joint, with Heberden’s nodes and nail grooving
  • Occult dorsal ganglion. Dorsal wrist pain without a palpable mass
  • Intraosseous ganglion. Lytic carpal lesion, often in the lunate

Clinical Features

  • Smooth firm mass that transilluminates
  • Size fluctuates with activity
  • Median or ulnar nerve compression from ganglia in the carpal tunnel or Guyon’s canal

Investigations

  • Ultrasound confirms a cystic lesion and its stalk
  • MRI for occult ganglia
  • Radiographs to exclude arthritis or an intraosseous lesion

Differential Diagnosis

  • Giant cell tumour of tendon sheath
  • Lipoma
  • Extensor tenosynovitis
  • Carpal boss
  • Radial artery aneurysm for volar wrist masses

Management

  • Observation. About half resolve without treatment
  • Aspiration. Recurrence above 50% at most sites, lower for flexor sheath ganglia
  • Open excision. Recurrence about 5% when the stalk and a cuff of capsule are excised, see Ganglion Excision
  • Arthroscopic excision. Option for dorsal wrist ganglia, resecting the stalk and adjacent capsule
  • Mucous cyst excision. Combined with DIP joint osteophyte debridement to reduce recurrence

Complications

  • Recurrence
  • Radial artery injury during volar excision
  • Wrist stiffness and scapholunate ligament injury

References

  1. Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. 1999, 7(4), 231-8. PubMed
  2. Gude W, Morelli V. Ganglion cysts of the wrist. Pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008, 1(3-4), 205-11. PubMed

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.