Dr Pr. D’Agostino, MD, PhD

Hand Clinic Brussels - Lasne

LOUISE +32 2 534 29 99 LASNE +32 2 653 11 11

Synovial cyst

QT Pathologies (EN)

Ganglion cysts are very common lumps within the hand and wrist that occur adjacent to joints or tendons.

It often resembles a water balloon on a stalk, and is filled with clear fluid or gel.

The most common types are :

Dorsal wrist ganglion cyst. Typically occurs in young adults and often disappears spontaneously.

Palmar wrist ganglion cyst. May occur in young adults, but also seen in association with wrist arthritis in older individuals.

Flexor tendon sheath ganglion cyst. Typically occurs in young adults, causing pain when gripping and feeling like a dried pea sitting on the tendon sheath at the base of the finger.

Dorsal digital ganglion cyst. Usually in middle-aged or older people and associated with wearing out of the end joint of a finger. Pressure from the cyst may cause a furrow in the fingernail. Occasionally the cyst fluid leaks through the thin overlying skin from time to time (see Mucous Cyst of the finger section).

  • Clinical aspect of a palmar synovial cyst of the wrist Clinical aspect of a palmar synovial cyst of the wrist
  • Clinical aspect of a dorsal synovial cyst of the wrist (radiocarpal origin - scapholunate) Clinical aspect of a dorsal synovial cyst of the wrist (radiocarpal origin - scapholunate)
  • Clinical aspect of a dorsal synovial cyst of the wrist (carpometacarpal origin ) Clinical aspect of a dorsal synovial cyst of the wrist (carpometacarpal origin )
  • Clinical aspect of a dorsal tenosynovial cyst of the second extensor compartment (ECRB-ECRL) Clinical aspect of a dorsal tenosynovial cyst of the second extensor compartment (ECRB-ECRL)

The cause of these cysts is unknown although they may form in the presence of joint or tendon irritation or mechanical changes. They occur in patients of all ages.

These cysts may change in size and they may or may not be painful. These cysts are not cancerous and will not spread to other areas.

A swelling beneath the skin becomes noticeable. It may or may not be painful.

The diagnosis is usually based on the location of the lump and its appearance. They are usually oval or round and may be soft or very firm. Cysts at the base of the finger on the palm side are typically very firm, pea sized nodules that are tender to applied pressure, such as when gripping.

Your physician may request x rays in order to investigate problems in adjacent joints. Cysts at the end joint of the finger frequently have an arthritic bone spur associated with them.

Ultrasound may be useful for studying the origin, nature, outlines and reports of the cyst with adjacent structures.

Treatment can be non-surgical. In many cases, these cysts can simply be observed, especially if they are painless and don't impair mobility. If the cyst becomes painful, limits activity, or is otherwise unacceptable, several treatment options are available.

The use of splints and anti-inflammatory medication can be prescribed in order to decrease pain associated with activities. An aspiration can be performed to remove the fluid from the cyst and decompress it. Aspiration is a very simple procedure, but recurrence of the cyst is highly common (> 60% recurrence). Care is needed, especially for palmar cyst, often close to the artery at the wrist (where you can feel the pulse).

If non-surgical options fail to provide relief or if the cyst recurs, surgical alternatives are available. Surgery involves removing the cyst along with a portion of the joint capsule or tendon sheath.

Surgical treatment is generally successful although cysts may recur (6-10%).

During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.

  • Macroscopic aspect of « water balloon on a stalk » of a dorsal synovial cyst of the wrist (left) and palmar synovial cyst of the wrist (right) Macroscopic aspect of « water balloon on a stalk » of a dorsal synovial cyst of the wrist (left) and palmar synovial cyst of the wrist (right)
  • Tenosynovial cyst of the index Tenosynovial cyst of the index