Orthopedic surgeon and hand expert, Dr. Jeffrey E. Budoff, MD

Arthroscopic and open surgery of the hand, wrist, elbow and shoulder

Retinacular Cysts

Hand Surgery Houston

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Tender masses that appear in the palm by the base of a finger are usually retinacular cysts. Retinacular cysts are simply ganglion cysts that come from the flexor tendon sheath of the finger. Retinacular cysts often lead to pain when gripping objects. Fortunately, they are benign and easily treated.

Initial treatment is by aspiration with a needle, removing the fluid from the center of the cyst. If the cyst’s walls are thin, the cyst will disappear. If the walls of the cyst are thick, a smaller, less tender mass may still be palpable. If the aspiration doesn’t change the cyst at all, then the mass is probably not a cyst, and an MRI and possible surgical excision should be considered.


Retinacular Cyst Excision with a Piece of the Tendon Sheath from which it Originated

Aspiration is usually successful in treating retinacular cysts. However, as for ganglion cysts elsewhere, once a cyst recurs, further aspirations will probably not be effective treatment. If a retinacular cyst returns following a successful aspiration, then the options are to live with it or have it removed surgically.

Fortunately, the surgery is a quick outpatient procedure. The cyst is removed along with a section of the flexor tendon sheath from which it originated. The section of the sheath is removed in order to prevent recurrence, which is rare if this step is performed. This is similar to removing a section of joint capsule when excising ganglion cysts (see the Ganglion Cysts section for more information).

After surgery, keep the hand clean and dry for 3 days. Bathing is safer than showering. Wrap a towel around the hand in case any water gets in, then place a plastic bag over the hand and secure it tightly with rubber bands. After 3 days showering is allowed. Avoid submerging the hand under water for 10 days. There’s a piece of special tape over the wound. The longer it stays, the nicer the wound will look. It’ll fall off when it’s ready. There are no stitches to remove. I recommend avoiding heavy activities like lifting and gripping for 2 weeks after surgery, in order to minimize post-operative pain.

In conclusion, tender masses near the junction of a finger and the hand are often retinacular cysts, which are easily curable by experienced hand surgeons.