These are typically non-cancerous masses that develop along tendons or around joints in the hands and wrists. They can also occur elsewhere in the body, including the ankles and feet. They are filled with a jelly like substance and are typically round in shape. These may come and go on their own, becoming raised and decreasing in size with everyday activities. Ganglion cysts can often be left untreated if they do not cause pain or discomfort. However, if they do cause any pain or deficits to range of motion or strength, they can be drained by a needle or surgically removed.

• The cause is often unknown, however it does occur after injury to a joint or tendon, causing fluid to leak
• Typically, it seems to occur when tissue around the tendon or joint bulges out of place, forming the cyst. The fluid increases and decreases in normal everyday activities, causing the cyst to be visible or disappear as well as go from asymptomatic to symptomatic and back from time to time.
• Most often occurs in women between 20-40 years of age, in those with arthritis, and those with a past history of injury to a joint

• Most often presents as a physical lump
• Often, these are “asymptomatic” besides the visible lump
• Can sometimes present with pain, weakness, decreased mobility, and tingling/numbness

• Since the cause is unknown, it is difficult to fully prevent ganglion cysts
• Overall health of joints is important such as avoiding injury or overuse
• Resting and stretching of hands and wrists are important throughout activities

• X-rays are done to rule out other bone conditions
• MRI typically visualizes these ganglion cysts, especially if there is pain with no visible lump. It can also help differentiate a cyst from tumor or other soft tissue mass or injury

• Typically, non-surgical options include observation, if there is no pain or other symptom, immobilization to allow for rest to decrease the size of the cyst and therefore decrease any symptoms, or aspiration, which is a needle to drain the fluid from the cyst to decrease the size
• If non-surgical conservative approaches fail, surgery can be done to remove the cyst. This is done if pain continues or the cyst continues to grow in size. The cyst and the surrounding structures are excised. Sometimes, a cyst can still recur after this procedure.

• Hand therapy is initiated to address range of motion, pain, and strength
• Splinting- custom thermoplastic splints are made to immobilize and decrease the size of the cyst. Edema sleeves can also benefit in helping to decrease the size of the cyst
• Modalities- moist heat, ice, ultrasound, infrared laser to decrease inflammation and pain
• Manual therapy- this includes scar massage after surgical intervention, soft tissue mobilization, or manual edema mobilization to decrease edema in the hand and wrist and improve symptoms
• Therapeutic exercise- exercises such as tendon glides, range of motion for hands and wrist
• Home exercise education- education on activity modification, prevention, and treatment plan