Abstract The ganglion cyst is the commonest soft-tissue swelling in the hand and wrist. It is a fibrous swelling that arises near a joint or tendon sheath, and contains clear mucinous fluid. The exact pathogenesis of the ganglion is unknown, although various theories quote anatomical and physiological evidence to support them. Ganglia can occur near any joint in the body, although they are encountered most commonly in the wrist and hand. They can present in a diverse number of ways. In cases of diagnostic uncertainty, they can be investigated by imaging techniques. If a ganglion is symptomatic, it should be treated by conservative means initially including aspiration. Steroids have no place in their management. If this strategy fails, then excision is required, it should be radical to minimise the risk of recurrence. Further research into the pathophysiology may allow improvement in treatment.