Ganglion Cysts in Children – Information for Referrers

Ganglions are the most common swelling around the wrist. They occur commonly in children and usually disappear on their own. They often cause parents and families concern but in almost all cases no intervention is required.

They occur most commonly on the dorsal aspect of the wrist or the base of the long fingers on the palmar aspect. They can however appear adjacent to any joint. It is not unusual to complain of some pain from time to time but usually this is self-limiting and not severe. Simple analgesia and application of ice may be helpful. They are not a sign of an underlying problem.

For the vast majority therefore we like to pass on our reassurance that it is quite safe to simply observe this and usually the cyst settles down over time.

The main issue with ganglions is being confident with the diagnosis. The following criteria are reassuring and strongly suggest a simple ganglion:

• Rapid appearance but comes and goes.
• Smooth not fixed to overlying skin.
• Typical location on dorsum of wrist.
• May be fluctuant but can feel quite hard
• Transluminates.

Usually a ganglion is a clinical diagnosis.

No. The dorsal wrist ganglion is particularly common in older children and young adults. It is often self-limiting and harmless. Ganglion cysts can arise from any joint or synovial tendon sheath but there are 4 very common areas around the wrist:

• Back of the wrist
• Front of the wrist
• Base of the thumb
• Base of the finger.

All ganglions eventually resolve (often over 1-2 years) and so we do not recommend any treatment for the asymptomatic or mildly symptomatic lesions. If a patient is experiencing pain then decompression under local anaesthetic can be carried out. This will not usually resolve the ganglion but can reduce discomfort. Surgical excision of ganglions is rarely carried out in paediatric populations unless there is a diagnostic uncertainty. Recurrence after surgery is common. The scar can produce persistent pain and tenderness. The risk of surgery is generally thought to outweigh any benefit.

• Significant pain and discomfort – may be considered for aspiration or surgery.
• Uncertain diagnosis.
• Ongoing parental concerns.