A ganglion cyst in the hand or palm is a sac of joint or tendon-sheath fluid that has pushed its way out through a weak point.
It is not a tumour, it is not cancer, and it will not spread.
The one in the palm, at the base of a finger, is called a retinacular or SEED ganglion… and unlike the big soft ones on the wrist, it is small, rock hard, and hurts far more than its size suggests.
Why the palm ones feel so different
A wrist ganglion sits on the back of the wrist with soft tissue and space around it. It gets big, it wobbles, and most of the time it doesn’t hurt at all.
The palm version has nowhere to go.
It grows off the flexor tendon sheath, right at the crease at the base of the finger, and that is exactly where you press down on a steering wheel, a shopping bag handle, a golf club, a bicycle grip.
So it stays the size of a peppercorn and still ruins gripping. Patients describe it as standing on a small stone, but in the hand.
In the hand, the pain of a lump is decided by where it sits, not by how big it is.
The test that separates it from trigger finger
This is the confusion I see most, and it’s an easy one to sort out at home.
Both a seed ganglion and an early trigger finger nodule sit in the same spot, feel like a hard lump, and hurt when you grip.
The difference is whether the lump MOVES.
- Find the lump with your other thumb and hold it there
- Now slowly curl and straighten the finger
- Lump slides up and down under your thumb — that’s a thickened tendon nodule. Trigger finger territory.
- Lump stays exactly where it is — that’s a ganglion sitting on the sheath itself, not in the tendon.
The second difference: trigger finger catches, clicks or locks. A seed ganglion never does. It just hurts when you press on it.
I do this test with the patient’s own hand doing the feeling. People believe their own fingers more than they believe me.
The other places they turn up
Back of the hand, over the knuckles. Usually from the joint underneath. Soft, changes size with activity, rarely serious.
Front of the wrist, on the thumb side. This one sits close to the radial artery, which matters if anyone suggests removing it — it makes the surgery genuinely more delicate, not a five-minute job.
At the end joint of a finger, with a nail groove. That’s a mucous cyst and it’s a different animal, driven by arthritis in the joint below it.
Hard, bony, immovable, back of the wrist. Probably not a cyst at all. A carpal boss is extra bone, and no amount of aspiration will touch it.
What to do about it
Honest answer first: most of them need nothing done.
A meaningful proportion resolve on their own over months to a couple of years. If it doesn’t hurt and it doesn’t limit you, watching it is a legitimate medical plan, not laziness.
- Padding and grip change — a padded glove, thicker handles, moving the pressure off the lump. Fixes the symptom in a lot of palm ganglions without touching the cyst.
- Aspiration — a needle drains the jelly. Fast, done in clinic. Recurrence is common, because the stalk that feeds it is still there.
- Surgery — takes the cyst AND the stalk, which is why it recurs less. Still not never. And recovery is longer than people expect, with scar tenderness in the palm being the usual complaint at week 6.
And please, do not hit it with a book.
The old “Bible cyst” trick works occasionally and is a good way to break something that wasn’t broken. We have needles now…with guided imagery. A lot more accurate and a lot less pain…
When a lump is not a ganglion
Get it looked at properly rather than assumed, if the lump:
- Is growing steadily and never shrinks
- Is firm, fixed and doesn’t transilluminate when a torch is held against it
- Causes numbness or tingling in the finger beyond it
- Is painful at night, at rest, for no reason
- Appeared after a penetrating injury, especially with redness
Most hand lumps are boring. The few that aren’t tend to be steadily growing and painless, which is precisely why they get ignored for a year.
A ganglion that changes size is behaving normally. A lump that only ever gets bigger deserves a scan.
If your lump is stopping you gripping, or you can’t work out whether it’s a cyst or a tendon nodule, get a hand therapist or hand surgeon to feel it. Two minutes of examination settles a question that Google will keep you awake over.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.