Coastal Plastic Surgery & Medi Spa — Erina NSW Ganglions & Hand Tumours
Ganglion cysts are the most common soft tissue tumours of the hand and wrist. Most are benign and harmless, but they can cause pain, limit movement, or be cosmetically bothersome. Our specialist plastic surgeons offer aspiration and surgical excision for ganglions and a range of other benign hand tumours.
What is a ganglion cyst?
Ganglion cysts are the most common benign soft tissue tumours of the hand and wrist, accounting for approximately 60–70% of all hand and wrist lumps. They are fluid-filled sacs that arise from the lining of a joint or tendon sheath, most commonly at the back of the wrist, the front of the wrist, or at the base or top of a finger.
The fluid inside a ganglion is thick, viscous, and gelatinous — similar in consistency to joint fluid (synovial fluid). The cyst is connected to the underlying joint or tendon sheath by a stalk, which acts like a one-way valve allowing fluid to enter but not exit.
Ganglions can vary considerably in size — from very small (occult ganglions that are not visible but can be felt or cause symptoms) to several centimetres in diameter. They may change in size over time, sometimes appearing to resolve spontaneously before recurring.
The exact cause of ganglion cysts is not fully understood. They are thought to be associated with repetitive stress, prior wrist sprains or injuries, and joint degeneration — though they often arise without any identifiable cause.
Dorsal wrist ganglion — the most common type, arising on the back of the wrist from the scapholunate ligament. Typically smooth, firm, and transilluminates (lights up when a torch is held against it).
Volar wrist ganglion — arises on the palm side of the wrist, often adjacent to the radial artery. Requires careful assessment before aspiration due to proximity to vascular structures.
Flexor tendon sheath ganglion (seed ganglion) — a small, firm nodule at the base of the finger on the palm side, often mistaken for a callus. Usually very tender to direct pressure.
Mucous cyst — a ganglion arising at the end joint of the finger (DIP joint), associated with osteoarthritis. Can cause nail deformity if it compresses the nail matrix.
While most hand lumps are benign ganglion cysts, any new or changing lump in the hand or wrist should be assessed by a specialist to exclude less common diagnoses. Not all hand lumps are ganglions — and not all hand tumours are benign. A clinical examination and, where indicated, imaging will confirm the diagnosis.
Benign hand tumours we treat
In addition to ganglion cysts, our specialist plastic surgeons assess and treat a range of other benign soft tissue tumours of the hand, fingers, and wrist. The following are among the most common.
Giant Cell Tumour of Tendon Sheath (GCTTS)
The second most common benign hand tumour after ganglions. A firm, painless, slowly growing nodule that arises from a tendon sheath — most commonly on the fingers or palm side of the hand. Surgical excision is the treatment of choice, though recurrence rates are higher than for ganglions.
Lipoma
Soft, mobile, benign fatty tumours that can occur in the hand and palm. They are generally painless but may cause discomfort if they compress adjacent nerves or tendons. Surgical excision is curative.
Glomus Tumour
A small, highly painful benign vascular tumour that most commonly occurs under the fingernail. The classic triad is severe localised pain, point tenderness, and cold sensitivity. Surgical excision under magnification is curative and results in immediate relief of pain.
Inclusion Cyst (Epidermal Cyst)
A cyst filled with keratin that forms in the skin of the hand or finger, often following a penetrating injury. Surgical excision including the cyst wall is required to prevent recurrence.
Enchondroma
A benign cartilaginous tumour that arises within the bone of the finger (most commonly the proximal phalanx). Often discovered incidentally on X-ray. May weaken the bone and predispose to pathological fracture. Management includes observation or surgical curettage and bone grafting.
Vascular Malformations & Haemangiomas
Abnormal collections of blood vessels in the soft tissues of the hand. Can cause pain, swelling, and functional limitation. Management depends on the type and extent of the lesion and may involve observation, sclerotherapy, or surgical excision.
Fibroma & Neurofibroma
Benign fibrous or nerve-sheath tumours that can arise in the soft tissues or along nerves of the hand. They may cause nerve compression symptoms. Surgical excision is the treatment of choice.
Other Soft Tissue & Bony Tumours
Less common tumours — including osteoid osteoma, bone cysts, and soft tissue sarcomas — may also present as hand or wrist lumps. A thorough clinical assessment and appropriate imaging are essential to exclude these diagnoses before assuming a lump is benign.
How are hand tumours diagnosed?
Most ganglions can be diagnosed clinically on the basis of their location, appearance, consistency, and transillumination. However, imaging is often helpful — particularly for atypical presentations, deep or occult lesions, or where the diagnosis is uncertain.
Ultrasound is the most useful first-line investigation — it can confirm the cystic nature of a ganglion, identify the stalk, and assess the relationship to adjacent structures including nerves and blood vessels.
MRI provides detailed soft tissue information and is used for deeper or more complex lesions, assessment of suspected solid tumours, and pre-operative planning for excision.
X-ray is used to assess for underlying bony changes, particularly for mucous cysts (DIP joint osteoarthritis) and bony lesions such as enchondroma.
Not all ganglions are visible as a lump. Occult ganglions are small cysts that lie beneath the tendons or deep within the wrist and cannot be seen from the surface. They can cause significant pain, weakness, or restricted movement without any obvious swelling. Ultrasound or MRI is required to identify these lesions. If you have unexplained wrist pain without a visible lump, an occult ganglion should be considered.
All tissue excised during surgery at Coastal Plastic Surgery is sent for histological (laboratory) analysis to confirm the diagnosis. This is important even for lesions that appear clinically benign, as it provides pathological confirmation and ensures nothing unexpected is missed.
How are ganglions and hand tumours treated?
Not all ganglions require treatment. Many are asymptomatic and can simply be monitored. When treatment is required — due to pain, functional limitation, or cosmetic concern — the options are aspiration or surgical excision.
Active Monitoring
For asymptomatic ganglions that are not causing pain, weakness, or functional limitation, observation is a reasonable approach. Up to 40–50% of ganglions resolve spontaneously over time. Regular review allows any change in size or symptoms to be monitored.
Aspiration
The ganglion is punctured with a needle and the gelatinous fluid is aspirated (withdrawn). This can be performed under local anaesthetic in-rooms. Aspiration provides immediate reduction in size, but recurrence rates are higher than with surgical excision (approximately 50%). Best suited to dorsal wrist ganglions.
Surgical Excision
The ganglion and its stalk are excised under local or general anaesthetic as a day procedure. Surgical excision has the lowest recurrence rate (approximately 10%) and allows histological confirmation. It is the preferred treatment for symptomatic ganglions, recurrent ganglions after aspiration, and for other solid hand tumours.
Arthroscopic Excision
Some wrist ganglions — particularly dorsal wrist ganglions — can be excised arthroscopically (using a small camera and instruments through keyhole incisions). This technique may result in faster recovery and a smaller scar for suitable cases.
Ganglion excision is typically performed as a day procedure under local anaesthetic. A dressing is applied and the hand is used for light activities within a few days. The wound is reviewed at 10–14 days. Most patients return to full activities within 2–4 weeks, depending on the site of the ganglion and the demands of their work or activities. Hand therapy may be recommended following excision of larger ganglions or those in close proximity to important structures.
Recurrence after ganglion excision occurs in approximately 10% of cases. If a ganglion recurs, further excision can be considered. Giant cell tumours of tendon sheath have higher recurrence rates (15–20%) due to their tendency to involve multiple tendon sheath compartments. Your surgeon will discuss the likelihood of recurrence for your specific tumour at consultation.
Other hand surgery services
Our specialist plastic surgeons
Ganglion excision and hand tumour surgery at Coastal Plastic Surgery is performed by our FRACS-qualified specialist plastic surgeons.
Common questions about ganglions & hand tumours
Not necessarily. Many ganglion cysts are asymptomatic and do not require treatment. Up to 40–50% resolve spontaneously over time. Treatment is generally recommended if the ganglion is causing pain, limiting wrist or finger movement, pressing on a nerve, or is cosmetically bothersome. Your surgeon will discuss the pros and cons of observation versus active treatment for your specific situation.
Aspiration is a simpler, quicker procedure that can provide immediate relief, but recurrence rates are approximately 50%. Surgical excision has a lower recurrence rate (approximately 10%) and allows histological confirmation, but involves a small incision and slightly longer recovery. The best approach depends on the type and location of the ganglion, whether it has recurred before, and the patient's preference. Your surgeon will discuss the most appropriate option at consultation.
Ganglion cysts are benign. They do not become cancerous and do not spread. However, not every lump in the hand is a ganglion — and not every hand lump is benign. It is important to have any new or changing hand lump assessed by a specialist to confirm the diagnosis. After surgical excision, all tissue is sent for histological analysis to provide pathological confirmation of the diagnosis.
Recurrence after surgical excision occurs in approximately 10% of cases — significantly lower than after aspiration. Recurrence is more common when the stalk of the ganglion is not completely excised, and for ganglions in certain locations. Giant cell tumours of tendon sheath have higher recurrence rates (15–20%). If a ganglion recurs, revision excision is an option. Your surgeon will advise on the recurrence risk for your specific lesion.
A small, firm, tender nodule at the base of the finger on the palm side is most likely a flexor tendon sheath ganglion (seed ganglion). These are often extremely tender to direct pressure — even from holding a steering wheel or pen. Despite their small size, they can cause significant discomfort. They can be treated with aspiration or surgical excision. If the lump is under the fingernail and associated with severe pain and cold sensitivity, a glomus tumour should be considered — this is a different benign but highly painful condition that requires surgical excision.
Ganglion excision is a medical procedure that attracts a Medicare item number. Applicable rebates will be included on your formal quote following consultation. If you have private health insurance, it may contribute to theatre and hospital costs if the procedure is performed in a hospital setting. Many ganglion excisions are performed under local anaesthetic in our rooms, which significantly reduces costs. Your surgeon will discuss costs at consultation.
Have a lump on your hand or wrist?
Book a consultation with our specialist plastic surgeons to have your hand lump properly assessed and discuss the most appropriate treatment options for your situation.