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A lump that appears on the wrist over a few weeks, sits under the skin and moves slightly when you press it is unsettling, mostly because the first thing anyone wants to rule out is something serious.
In the hand and wrist, the most common answer is a ganglion cyst. They are not cancerous, they are not an infection, and a good proportion of them need nothing done at all. Some do need attention, and a few are worth having looked at sooner rather than later.
This guide covers what a ganglion cyst is, where they turn up, what usually happens to them over time, and how to judge whether yours is one to watch or one to have assessed.
A ganglion cyst is a fluid filled swelling that arises from a joint capsule or a tendon sheath. The fluid inside is the same lubricating fluid that sits in the joint, and it is thick and jelly like rather than watery, which is why a ganglion feels firm rather than squashy.
The cyst usually has a stalk, a narrow connection back to the joint or tendon sheath it came from. That stalk matters more than it sounds, because it is the reason a cyst that has been drained can refill.
Ganglion cysts are the most common lump found in the hand and wrist. They are seen most often in adults between about 20 and 40, and more often in women than men, although they can appear at any age. Why any one person develops one is usually not clear. Repetitive hand use, a previous injury to the joint, and ordinary wear in the joint are all associated with them, but many people with a ganglion have none of those and no explanation is found.
Not everything that looks like a ganglion is one. Several other soft tissue lumps can look and feel similar, and a few uncommon ones need different treatment. Working out which is which is done by examining the lump, not by comparing it to a description online. That is the reason any new or changing lump is worth showing to a GP, even when you are fairly confident about what it is.
Ganglion cysts turn up in a few characteristic places, and where a cyst sits changes how it behaves and how much of a nuisance it is.
The wrist is by far the most common site. Most wrist ganglia sit on the back of the wrist, roughly in line with the middle of the hand, and they become more obvious when you bend the wrist forwards. A smaller number sit on the palm side, usually towards the thumb, near where the pulse is taken.
Wrist ganglia often change size. Many get larger with heavy use of the hand and shrink with rest, and some disappear for weeks and then come back. That fluctuation is typical and is not a sign that something is getting worse.
Some wrist ganglia are too small to see and are only felt as a firm spot, or are not felt at all and show up on a scan arranged for something else. These are sometimes described as occult ganglia, and they can be a source of wrist ache without an obvious lump to explain it.
In the finger, ganglia show up in two main places.
At the base of the finger, on the palm side, a small firm bead can form on the tendon sheath. These are often no bigger than a dried pea, they do not move much, and the usual complaint is not the lump itself but discomfort when gripping a steering wheel, a handlebar or a shopping bag.
Nearer the fingertip, a cyst can form at the last joint of the finger, next to the nail. These are associated with wear in that small joint. Because the cyst sits close to the nail bed, it can press on it and leave a groove or ridge running down the nail. Skin over this type of cyst can become thin, and if it breaks the joint underneath is exposed, which is the one situation in this article that warrants prompt medical attention.
Ganglion cysts on the foot are less common than in the hand, and they usually sit on the top of the foot or around the outer side of the ankle.
The difference on the foot is footwear. A cyst that would be barely noticeable on the back of a wrist becomes a daily problem when a shoe or a boot presses on it, and the pain people describe is often from that pressure rather than from the cyst itself. Changing footwear, or padding around rather than over the lump, is a reasonable first thing to try, and sometimes it is the only thing needed.
A lump on the foot that is painful when you stand on it, or that changes the way you walk, is worth having examined rather than worked around, because altering your gait tends to create a second problem elsewhere.
| Wrist | Finger | Foot and ankle | |
|---|---|---|---|
| Usual position | Back of the wrist, sometimes the palm side near the thumb | Base of the finger on the palm side, or beside the nail | Top of the foot or the outer ankle |
| Typical size | Pea to grape, often varies week to week | Usually small and firm | Small to moderate |
| Common complaint | Appearance, ache with heavy use, occasional weakness | Discomfort on gripping, nail ridging if near the nail | Pressure and rubbing inside footwear |
| Changes with activity | Often larger with use, smaller with rest | Less variable | Worse with tight or firm shoes |
| First thing to try | Rest and observation if painless | Observation if painless and not catching | Change footwear or pad around the lump |
These are the usual patterns rather than rules, and a cyst that behaves differently is not automatically a problem.
The question people ask most often is whether a ganglion cyst will go away by itself. Frequently it does. A substantial share of ganglion cysts settle without any treatment, though it can take months or a couple of years, and there is no reliable way to tell in advance which ones will.
The rest either stay much the same or fluctuate in size indefinitely. A cyst that has been present for years and is not causing symptoms is not, in itself, a reason to do anything.
This is why observation, sometimes described as watch and wait, is a genuine option rather than a way of putting off a decision. If a cyst is painless, is not limiting what you can do, and is not changing in a way that concerns you, leaving it alone and reviewing it later is a reasonable plan. You can change your mind at any point.
Ganglion cysts were once called Bible cysts, from the old practice of striking the lump with a heavy book to burst it. The advice still circulates, and it is a bad idea.
Hitting a cyst can bruise the tissue around it, damage structures underneath, and the cyst commonly refills afterwards because the stalk is untouched. The same applies to attempts to pierce or drain a cyst at home, which add a risk of infection to a lump that was not infected to begin with.
If a cyst has reached the point where you are considering doing something about it, that is the point to have it assessed properly.
Book an appointment if any of the following apply:
The last one is a legitimate reason on its own. A large part of what an assessment provides is a clear answer, and for many people that is the whole point of the visit.
Seek medical attention promptly if:
Outside clinic hours, Healthline is free on 0800 611 116, and in an emergency call 111.
Most ganglion cysts are recognised on examination. A clinician will ask how long the lump has been there, whether it has changed, what makes it worse, and what it stops you doing, then examine the lump and the joint it sits near, checking movement, grip and sensation.
Where the picture is less clear, imaging can be used to confirm what a lump is and to rule out other causes. An ultrasound scan is often enough to show whether a lump is fluid filled or solid. Other imaging is used less often and for specific questions.
The examination is also where other explanations get considered. Wrist pain with numbness or tingling in the fingers, for instance, is more often a nerve problem than a cyst, and that is assessed differently; our page on carpal tunnel surgery covers that side of things.
A general medical consultation at CityMed covers this kind of assessment, and where a procedure is appropriate it can usually be arranged from there.
Where a cyst is causing symptoms, there are two established options alongside observation. Both are described in more detail on our ganglion cyst page.
Aspiration means drawing the fluid out of the cyst with a needle, usually under local anaesthetic, sometimes followed by an injection into the cyst lining. It is quick, minimally invasive, and the lump goes down straight away.
The trade off is recurrence. Because the stalk connecting the cyst to the joint or tendon sheath is left in place, fluid can build up again, and for many people it does. Some cysts settle after one or more aspirations and others keep returning. It suits people who want the least invasive option first and accept that it may need repeating.
Surgical removal takes out the cyst together with its stalk, which is why recurrence after surgery is less likely than after aspiration, though it is still possible. At CityMed the procedure is performed under local anaesthetic in our procedure theatre, and aftercare covers wound care, gradual return to activity and, where it helps, some rehabilitation of the joint.
Surgery leaves a small scar, and there is a recovery period during which the hand or foot needs looking after. It is usually considered when a cyst is causing genuine problems, when aspiration has not held, or when the position of the cyst makes aspiration unsuitable.
Which option is appropriate depends on where the cyst is, what it is doing, what you need your hands or feet for, and your own preference. Current prices for minor surgery, including ganglion removal, are published on our surgery fees page.
| Observation | Aspiration | Surgical excision | |
|---|---|---|---|
| What it involves | Monitoring the cyst over time | Draining the fluid with a needle, often with an injection | Removing the cyst and its stalk |
| Anaesthetic | None | Local | Local |
| Downtime | None | Minimal | A recovery period with wound care |
| Chance of it returning | The cyst may settle, persist or fluctuate | Recurrence is common as the stalk remains. With an intralesional steroid injection, around 35 to 50% of cysts are reported to return | Reported to be successful in around 85 to 90% of cases. Recurrence is less likely than after aspiration, but still possible |
| Usually suits | Painless cysts that are not limiting anything | Symptomatic cysts where a less invasive step is preferred | Persistent or recurrent cysts, or those causing ongoing problems |
Often, yes. Many ganglion cysts settle without treatment, although it can take months or longer, and some persist. If a cyst is painless and not limiting what you do, waiting and reviewing it is a reasonable approach.
Ganglion cysts are not cancerous. They are fluid filled swellings arising from a joint or tendon sheath. That said, other kinds of lump can look similar, so a new or changing lump should be examined rather than assumed.
There is no home method that reliably removes one, and the traditional advice to strike it with a heavy book can cause bruising or injury to the tissue underneath. Draining or piercing a cyst at home also risks infection. If it is bothering you enough to want it gone, have it assessed.
Not always. The stalk connecting the cyst to the joint or tendon sheath stays in place after aspiration, so the cyst can refill, and recurrence is common. Some people need more than one aspiration, and some go on to consider surgery.
Generally yes. Gentle movement that does not cause pain is usually encouraged, and immobilising a joint for long periods tends to cause more problems than it solves. After a procedure, the advice you are given at the time takes precedence.
Fluctuation is typical of ganglion cysts. Many enlarge with heavy use of the joint and shrink with rest, and some disappear for a period before returning. A cyst that grows steadily rather than fluctuating is the one worth having checked.
Current prices for minor surgery at CityMed, including ganglion removal, are listed on our surgery fees page. Fees are reviewed from time to time, so that page is the reliable source rather than a figure quoted elsewhere.
CityMed provides general practice care and minor surgery in Auckland CBD, including assessment of ganglion cysts and other lumps of the hand, wrist and foot.
If a lump is painful, growing, or getting in the way of what you need to do, an assessment is the quickest route to a clear answer.
Book an appointment or get in touch, or call 09 377 5525.
This article is general health information and is not a substitute for individual medical advice. A lump should be assessed in person before anyone decides what it is or what to do about it. If you are concerned about a lump, please speak with your GP or another registered health professional.
General health information | Reviewed by Dr. Terry Zhang, GP | CityMed Medical Centre, Auckland CBD
