Should my teen get the cyst on her wrist aspirated? 

The old advice was to 'bash' a ganglion cyst with a Bible giving them their other name of 'Bible bumps'. This approach aims to burst the cyst without breaking the skin, however, this treatment is painful, risks bone fracture, and isn’t very effective

Dr Phil Kieran: "Ganglion cysts are a common fluid-filled lump that occurs over a joint line, most commonly on the wrist."

My 17-year-old developed a painless ganglion cyst on her left wrist about six months ago. The GP recommended letting it resolve by itself, but it's quite noticeable, and she's self-conscious about it. I've read online that they can be aspirated. What would you recommend?

Ganglion cysts are a common fluid-filled lump that occurs over a joint line, most commonly on the wrist. They are almost always relatively small and painless and are usually diagnosed by a GP. They are not dangerous and don’t damage the joint, and more than 50% will resolve by themselves over 12 months.

The old advice was to “bash them with a Bible,” giving them their other name of 'Bible bumps'. This approach aims to burst the cyst without breaking the skin, so there is no risk of introducing bacteria into the area. However, this treatment is painful, risks bone fracture, and isn’t very effective.

As you have read online, the cysts can be aspirated or drained with a needle. In this procedure, the skin is cleaned before a sterile needle is inserted into the cyst, with or without local anaesthetic, and an attempt is made to drain the cyst.

One of the most serious complications of this process would be if bacteria entered the needle site and infected the joint capsule. This is a remote risk, but it can happen whenever we break the skin and insert something near or into a joint. More commonly, this procedure can fail as the fluid in the cyst is quite thick and viscous, making it difficult to drain all or any of it.  Even if the aspiration is successful, in some studies, the recurrence or refilling rate can be as high as 70%.

The definitive treatment for larger or recurring ganglion cysts is usually surgical excision. This entails removing the sac that contains the fluid before closing the wound.  The procedure is usually very effective and relatively minor. It still carries the risks of aspiration and would leave a small scar, which needs to be considered, but the success rate is around 90%.

Given that ganglion cysts often resolve by themselves, I agree with your GP that if she can tolerate it, then that is the best course of action. Sometimes, the worry can be that they will continue to grow, and being reassured that they usually don’t grow too large can make them more tolerable.

If it is causing significant distress, then getting a referral to a medic who would aspirate it is not an unreasonable option. Because they can be quite visible, people can become very self-conscious of them, and this is something I would take fully into account when advising on a treatment plan.

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