- Discussion:
- type of muscinous filled cyst whch is found adjacent to joint capsule or tendon sheath;
- it consist of an outer fibrous coat and an inner synovial lining and contains a clear, colorless, gelatinous fluid;
- ganglions usually occurs singly but may be multilocular;
- more common in women
-
age:
- 70% occur between the second and fourth decades
- ganglions occurring at DIP joint (
mucous cyst) are associated w/ osteoarthritis and occur at older ages;
- rarely seen in children;
- in the report by AA Wang et al (J.Hand.Surg. 2001, Vol 26-A, p 599) the authors evaluated 14 children less than 10 years of age who presented
with cysts of the hand and wrist;
- masses included 7 retinacular cysts, 5 volar wrist ganglia, and 2 dorsal wrist ganglia;
- none of the cysts were painful and 79% of the cysts resolved spontaneously within a year;
-
location:
- frequent in hand and wrist, less often in ankle, foot, and knee;
- most common soft tissue mass of hand is ganglion;
-
dorsal ganglion: 60-70% of all ganglia over scapholunate ligament;
-
volar ganglion:
- 20% of all ganglia
- most common site at volar wrist crease between the
FCR and
APL at the scaphotrapezoid joint;
-
differential dx: (see
diff dx: dorsal wrist pain);
-
Synovial Sarcoma:
-
Extra-Skeletal Chondrosarcoma:
-
AVN
- Venous Aneuysm:
- Clinical Presentation & Exam:
-
dorsal wrist pain which is made worse w/ repeated use;
- a slow growing, localized swelling, with mild aching and weakness;
- cyst is firm, smooth, rubbery, rounded, slightly flutuant, and at times tender;
- cysts will transilluminate;
- it is usually fixed but may be slightly movable if it involves tendon sheath;
- mass may become obvious w/ wrist flexion;
- palpation of cyst w/ compression may not only the extent of the cyst but also the direction of pedicle;
-
occult ganglia;
- source of similar symptoms, esp young gymnasts;
- discomfort is usually maximal in extension;
- point tenderness is directly over scapholunate interval;
- attempt to palpate mass over scapholunate w/ wrist in volar flexion;
- Radiographs:
- usually negative;
-
arthrography is usually not helpful;
- dorsal ganglions may be found w/
scapholunate diastasis;
- if this is the case, inform the patient before surgery, to that excision of the ganglion is not blamed for future instability;
- Surgical Treatment:
-
Dorsal Wrist Ganglions:
-
Volar Wrist Ganglions:
The volar wrist ganglion: just a simple cyst
The treatment of dorsal wrist ganglia by radical excision.
Aspiration of ganglia.
Management of ganglion cysts of the hand by simple aspiration.
Efficacy of immobilization following aspiration of carpal and digital ganglions.
Intraosseous ganglia of carpal bones.
Efficacy of immobilization following aspiration of carpal and digital ganglions.
Dorsal wrist pain and the occult scapholunate ganglion.
The treatment of dorsal wrist ganglia by radical excision.
Scapholunate instability following ganglion cyst excision. A case report.
Original Communications. Venous aneurysms of the wrist Edward D. Wang, MD JHS Sep 2001 Vol 26 Number 5
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