[12] Ganglionic Cysts Flashcards
What are ganglionic cysts?
Non-cancerous soft tissue lumps that occur along any joint or tendon
What do ganglionic cysts arise from?
Denegeration within the joint capsule or tendon sheath of the joint, subsequently becoming filled with synvoial fluid
Where are ganglionic cysts most commonly found?
Hands and feet
What % of ganglionic cysts appear on the dorsal aspect of the wrist?
60-70
Which gender are ganglionic cysts more common in?
Females
What is the peak age of onset of ganglionic cysts?
20-40 years old
What are the main risk factors for the development of ganglionic cysts?
- Female
- Osteoarthritis
- Previous joint or tendon injury
Why does osteoarthritis increase the risk of the development of ganglionic cysts?
Because it can cause an increase of the fluid in the joint, resulting in leakage through the tendon sheath into the cyst
How does a ganglionic cyst typically present?
As a smooth, spherical, painless lump adjacent to the joint affected
How quickly does a ganglionic cyst develop?
It may appear suddenly or have grown over time.
In some cases, the cyst may have subsided initially to then reappear at a later date
What will be found on examination in ganglionic cysts?
The lump will be soft and will transilluminate, however may mechanically restrict the full range of motion of the affected joint
What can happen if a ganglionic cyst exerts any pressure on adjacent nerve(s)?
The patient may present with localised paresthesia, pain, or motor weakness
What are the differential diagnoses of ganglionic cysts?
- Tenosynovitis
- Giant cell tumour of tendon sheath
- Lipoma
- Osteoarthritis
- Sarcoma
How can tenosynovitis be differentiated from ganglionic cysts?
Tenosynvoitis has no discrete mass, with swelling tracking along the tendon
How can a giant cell tumour of the tendon sheath be differentiated from ganglionic cysts?
Giant cell tumours are a solid mas that does not transluminate and is fixed to the underlying sheath (therefore is less mobile than a cyst)
How is a lipoma differentiated from a ganglionic cyst?
It will not be entirely spherical, and does not transilluminate
How is osteoarthritis differentiated from a ganglionic cyst?
Osteoarthritis presents as a palpable, hard, non-cystic, and immobile mass that does not trans-illuminate.
It is usually accompanied by a long standing osteoarthritis of the scaphotrapeziotrapezoid joint
How is sarcoma differentiated from a ganglionic cyst?
Typically not well circumscribed or mobile lesions
How are most ganglionic cysts diagnosed?
Clinically
How might a plain film radiograph be useful in ganglionic cysts?
May assist in ruling out osteoarthritis or bone malignancies as diffentials, as ganglions cannot be visualised via x-ray
What investigations can be done in uncertain cases of ganglionic cysts?
Imaging via ultrasound or MRI
What is the purpose of ultrasound or MRI imaging in ganglionic cysts?
Can assess the shape, size, and depth of teh cyst.
Due to their high sensitivity, such imaging may also pick up incidental cysts that have not yet grown large enough to be symptomatic
What is the purpose of aspiration of ganglionic cysts?
- Temporary symptomatic relief
- Assessment of extracted fluid with microscopy +/- cytology
What is the limitation of aspiration of ganglionic cysts for symptomatic relief?
There is a high rate of recurrence
How is a ganglionic cyst managed if it is not causing pain?
The usual recommendation is to monitor
Why is the recommendation to monitor if the ganglionic cyst is not causing pain?
Because cysts often disappear spontaneously without further intervention
How are ganglionic cysts managed if they cause pain or severely limit the range of movement?
There are two main interventions;
- Aspiration, with or wihtout steroid injection
- Cyst excision
What is the problem with aspiration in ganglionic cysts?
It is associated with infection and high rate of recurrence
What is the limitation of steroid injections in ganglionic cysts?
There it limited evidence demonstrating a clear benefit of steroid injections in the ganglion
What does cyst excision involve in ganglionic cysts?
Removing the cyst capsule along with a portion of the associated tendon sheath
Can recurrence occur with cyst excision?
Yes, but recurrence is less than with aspiration
What is cyst excision often reserved for?
Symptomatic cases with recurrence following aspiration
