- 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 Wang ED, et al (2001) 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
- Venous aneurysms of the wrist
- 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;
- references:
- Dorsal wrist pain and the occult scapholunate ganglion.
- Occult scapholunate ganglion: a cause of dorsal wrist pain.
- 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;
- Non Operative Treatment:
- aspiration followed by 3 weeks of immobilization may be successful in 30-50% of patients;
- usually a 16 gauge needle is required inorder to successfully aspirate the
- note: aspiration the characteristic gelatinous fluid is also useful to rule out the rare occurance of a malignant tumor
masquerading as a cyst;
- in case of a malignant tumor, it is unfortunate to make diagnosis, only after a transverse incision has been made across wrist;
- references:
- Aspiration of ganglia.
- Management of ganglion cysts of the hand by simple aspiration.
- Efficacy of immobilization following aspiration of carpal and digital ganglions.
- Surgical Treatment:
- Dorsal Wrist Ganglions:
- Arthroscopic Excision: (wrist arthroscopy)
- Prospective Outcomes and Associations of Wrist Ganglion Cysts Resected Arthroscopically
- Volar Wrist Ganglions:
- The volar wrist ganglion: just a simple cyst?
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