Many times, we often see clients with varying lumps and bumps of the hand and wrist. A ganglion can be a common diagnosis of these lumps and can often become painful. Ganglion cysts are a common soft tissue mass in the upper extremity. Essentially, they are a sack of fluid arising from a joint or tendon.

In the hand, the most common place for a ganglion is on the back of the wrist. Known as a dorsal wrist ganglion, this ganglion arises from the scapholunate ligament.  The cyst itself is usually painless, however, once it becomes large enough to exert pressure on surrounding structures, it can become painful. You may feel pain with full wrist flexion or extension of the wrist or when leaning through the hand (e.g. when doing push ups).  The ganglion itself may fluctuate in size or spontaneously resolve. These cysts are not cancerous and will not spread to other areas.

Your therapist can diagnose a ganglion by observation of where the cyst is and what it looks like, as well as the symptoms you are feeling. It can also be diagnosed by ultrasound, but this is not always necessary.

As ganglions can spontaneously resolve, often a period of rest can help. Your therapist can provide you with a wrist brace or splint to unload the wrist and allow it to rest.

If rest and splinting isn’t enough, aspiration (with or without a corticosteroid injection) by a surgeon may be the next step. Aspiration is a simple procedure, however, the recurrence rate of scapholunate ganglions following aspiration may be as high at 60%.

If non-surgical options fail to provide you relief or if the cyst reoccurs, surgical excision of the ganglion may be indicated. It is generally performed in a hospital as day surgery. Following surgery, your wrist will be rested in a splint or back slab plaster for a few days, after which, your hand therapy can commence.

Hand therapy can include education, advice on activity modification, scar management, pain relieving strategies, taping, range of motion, stretching and strengthening exercises. Full flexion of the wrist may be limited initially but will return with time and appropriate exercise.

We work closely with people who experience pain in their hands and wrists.  If you need further advice, please feel free to contact us on 02 6925 0157 or This email address is being protected from spambots. You need JavaScript enabled to view it.

Written by Ashley Pattison, Physiotherapist, Riverina Hand Therapy