Ganglion Cyst (Wrist)

Some features point towards a ganglion: a smooth lump on the back of the hand or wrist that changes size over time ², in a young to middle-aged adult ^1,2. But those are clues. They aren't a diagnosis.

That's why a GP visit is the right first step for any new lump, to make sure it isn't something else ¹. An ultrasound can show whether it's filled with fluid or solid ¹. Once it's confirmed as a ganglion, we can help most.

No lump, just wrist pain? The Hand section of our Injury Finder covers other hand and wrist problems.

Most ganglion cysts are diagnosed by looking and feeling. It's rare to need more testing ⁶. Your doctor will ask how long you've had the lump, whether it changes size and whether it hurts, and may press on it to check for tenderness ⁶. There's a simple torch test too: a light held against a fluid-filled ganglion passes through it, and a solid lump blocks it ⁶.

Scans are for the less clear cases, such as wrist pain with no obvious lump ⁶. An MRI can find a small cyst that can't be seen or felt ^{1 6}. An X-ray won't show the cyst itself, but it can show arthritis in the joint underneath ⁶.

We haven't found good evidence that physiotherapy, exercise or a splint on their own make a wrist ganglion disappear. A 2022 systematic review of treatment trials didn't study physiotherapy, and it rated the evidence it did find as low quality ⁴. What we can do is keep your hand working while the cyst runs its course, and help you recover if it's removed.

Wrist splints and braces. We may suggest one short-term for a painful task, but we're not aware of good evidence that a splint alone makes a ganglion go away. After a procedure, a splint is often worn for about a week. Longer can stiffen the joint ².

Aspiration (not something we do). A doctor drains the fluid with a needle. It's quick, but roughly half of cysts come back ¹. Across studies, recurrence has ranged from 7% to 72% ⁴. It's outside a physiotherapist's scope of practice, so that's a conversation with your GP.

Surgery (also not ours, but we're there afterwards). Cysts come back less often after removal: 6% to 41% after open surgery and 0% to 16% after keyhole surgery in the studies reviewed ⁴. But surgery has more complications ³, and a small number of people have ongoing pain and stiffness afterwards ¹. Recovery usually takes two to eight weeks ². That's where rehab comes in.

Therapy to stop it coming back. You may read that specialised hand therapy lowers the chance of a cyst returning. The 2022 review of treatment trials compared only drainage and surgery, not therapy ⁴. We'd rather tell you that than promise it.

No option is ideal, and one review says exactly that about every current treatment ³.

A ganglion does not heal on a schedule, so The Well Motion Recovery Path™ follows your wrist and not the lump. You move up a phase when the hand can do more, whether or not the cyst is still there.

• Reset: from your first visit, or the first days after a doctor drains or removes it. We change the grips and positions that set the pain off, sometimes with a splint for a painful task. Expect the lump to change size ². We move you on once everyday tasks stop flaring the wrist.
• Rebuild: hand rehabilitation for movement and grip, with manual therapy if the wrist is stiff. After surgery this starts early ² with repeated finger exercises ⁵. Expect grip to come back after movement does. We move you on when the wrist does what your daily tasks ask of it.
• Return: back to work, lifting, or weight through the hand in training. We test the tasks that used to hurt. You leave with a loading plan and the signs that mean a trip back to your GP ¹.

How long it usually takes. After surgery, recovery usually takes two to eight weeks ². Without a procedure the lump has no set time. In one study of adults followed for a mean of 70 months, 23 of 55 untreated cysts on the back of the wrist (58%) had gone ⁹. That is a single cohort answering a postal questionnaire.

Nobody knows what causes a ganglion, so there's no known way to stop the first one forming ^{1 2}. Whether it comes back after treatment is a different question, and that one has been counted:

• The treatment you choose matters most. Across 35 studies, the average return rate was 59% after needle drainage, 21% after open surgery and 6% after keyhole surgery ⁷. In the two randomised trials, surgery cut recurrence by 76% compared with drainage ⁷. Open surgery had more complications, though: 14% against 3% ⁷.
• Draining it isn't a shortcut. In the same review, drainage was no better than reassurance alone at keeping the lump away ⁷.
• Averages hide a wide spread. In one series of 628 open removals, the return rate ran from 2% to 11% depending on the surgeon ⁸. It's fair to ask yours how often they do this operation.
• Watch how yours behaves. Ganglions often swell with more activity and shrink with rest ⁶. If you think it's returning after treatment, see your doctor about what to do next ².