What is a Synovial Cyst: Causes, Symptoms and Treatments – Video Ambulatory Surgery


A ganglion cyst or synovial cyst is a tumor or swelling in the upper part of a joint (tissue that connects the muscle to the bone). It looks like a sack of fluid (cyst). There is thick, sticky, clear, colorless, gelatinous material inside the cyst. Depending on the size, the cysts may feel firm or spongy.

A giant cyst or many smaller ones may develop, but a standard stem in the deeper tissue usually connects them. This type of cyst is not harmful and represents approximately half of all soft tissue tumors of the hand.

Ganglion cysts, also known as cysts of the Bible, are more common in women, and 70% occur in people between the ages of 20 to 40 years. Rarely, ganglion cysts may occur in children under ten years of age.

Ganglion cysts occur in the back of the hand but may also appear on the palmar side of the wrist. Other places where they manifest are:

  • The base of the fingers on the palm, where they appear as small lumps the size of a pea.
  • The fingertips.
  • The outside of the knee and the ankle.
  • The upper part of the foot.

Causes of Synovial Cyst

The cause of ganglion cysts is not known. One theory suggests that the trauma causes the joint tissue to break, forming small cysts that later join into a larger, more obvious mass. The most likely theory is that it involves a defect in the envelope of the joint capsule or tendon that allows the tissue of the joints to protrude.

The symptoms

  • The ganglion usually appears as a lump.
  • It is generally smooth, anywhere 1-3 cm in diameter, and does not move.
  • The swelling may appear suddenly; it may disappear, only to return at another time.
  • Ganglion cysts cause pain after acute or repetitive trauma, but 35% are without symptoms, except for appearance.
  • If pain is present, it is usually chronic and worsens with joint movement.

Outpatient surgery to remove a cyst in the hand

Treatment of Synovial Cyst

There are three main non-surgical treatment options:

  • Observation and change of activity.
  • General non-surgical treatments for pain relief.
  • The injections.

Observation and modification of activity

If the synovial cyst is not creating a large amount of dysfunction or pain in the patient’s daily life, there are no medical treatments that may be necessary. Since certain positions usually cause pain, changing positions is reasonable to deal with pain.

General non-surgical treatments

Heat and cold therapy: applying ice and heat, which is especially effective for activities related to pain and discomfort.

Pain medications, including non-steroidal anti-inflammatory drugs (such as ibuprofen), acetaminophen, and prescription pain medications

Rest, which is more effective for brief periods.

Injections for synovial cysts

Two injections can help relieve pain: Faceted injections or epidural injections.

Facet injection. The facet joint can be penetrated with a small needle, and from time to time, the cyst can be drained by aspiration through the joint. Subsequently, the joint is injected with steroids to reduce inflammation.

Epidural steroid injection. The most common injection technique is injection around the cyst with steroids in the epidural space, known as an epidural injection.

It does not reduce the cyst, but it can reduce the pain. Although pain reduction is not very understood, it is thought to be due to a decrease in inflammation. It works well 50% of the time and not so well the remaining 50% of the time, and unfortunately, pain relief tends to be temporary.

Although the injection is not so reliable in the long term, it is reasonable to try since the only alternative is surgery. In general, no more than three injections are recommended in a year.