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Ganglions

Diagnosis/Definition

• Ganglion cysts arise from joint capsules or tendon sheaths.

• They are the most common benign soft tissue tumor of the hand and wrist.

• They are filled with inspissated fluid.

Initial Diagnosis and Management

• The anatomical location of ganglion cysts in descending order of frequency is: dorsal wrist, radiopalmar wrist,and arising from the annular pulley at the palmodigital crease.

• The history is of an enlarging mass that may vary over time and with activity. Complaints including aching or pain with wrist or digital motion.

• Examination reveals a palpable mass which is usually soft but occasionally firm. The masses are variably tender to direct pressure.

• Additional diagnostic tests include transillumination (digital ganglions usually do not transilluminate), aspiration or ultrasound.

• Initial management may be observation only, splinting to relieve acute discomfort or aspiration.

• Aspiration of radiovolar wrist ganglions may entail significant hazards and is not recommended.

Ongoing Management and Objectives

• The objective of initial management is resolution of symptoms, not necessarily disappearance of the cyst.

• Aspiration frequently results in recurrence.

• More definitive treatment need not be undertaken if the cyst is asymptomatic.

Indications for Specialty Care Referral

Failure to achieve a cosmetically and/or clinically acceptable result with non-surgical management.

Surgical removal of a ganglion cyst is a low risk low morbidity procedure done electively at the patient’s request.

Referral to hand surgery should be for surgical treatment.

Criteria for Return to Primary Care

Successful surgical treatment or refusal of surgical treatment.

Recurrence rate after surgical excision of a ganglion cyst is 5 to 10 percent.