[12] Ganglionic Cysts

Question 1

What are ganglionic cysts?

Answer 1

Non-cancerous soft tissue lumps that occur along any joint or tendon

Question 2

What do ganglionic cysts arise from?

Answer 2

Denegeration within the joint capsule or tendon sheath of the joint, subsequently becoming filled with synvoial fluid

Question 3

Where are ganglionic cysts most commonly found?

Answer 3

Hands and feet

Question 4

What % of ganglionic cysts appear on the dorsal aspect of the wrist?

Answer 4

60-70

Question 5

Which gender are ganglionic cysts more common in?

Answer 5

Females

Question 6

What is the peak age of onset of ganglionic cysts?

Answer 6

20-40 years old

Question 7

What are the main risk factors for the development of ganglionic cysts?

Answer 7

• Female
• Osteoarthritis
• Previous joint or tendon injury

Question 8

Why does osteoarthritis increase the risk of the development of ganglionic cysts?

Answer 8

Because it can cause an increase of the fluid in the joint, resulting in leakage through the tendon sheath into the cyst

Question 9

How does a ganglionic cyst typically present?

Answer 9

As a smooth, spherical, painless lump adjacent to the joint affected

Question 10

How quickly does a ganglionic cyst develop?

Answer 10

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

Question 11

What will be found on examination in ganglionic cysts?

Answer 11

The lump will be soft and will transilluminate, however may mechanically restrict the full range of motion of the affected joint

Question 12

What can happen if a ganglionic cyst exerts any pressure on adjacent nerve(s)?

Answer 12

The patient may present with localised paresthesia, pain, or motor weakness

Question 13

What are the differential diagnoses of ganglionic cysts?

Answer 13

• Tenosynovitis
• Giant cell tumour of tendon sheath
• Lipoma
• Osteoarthritis
• Sarcoma

Question 14

How can tenosynovitis be differentiated from ganglionic cysts?

Answer 14

Tenosynvoitis has no discrete mass, with swelling tracking along the tendon

Question 15

How can a giant cell tumour of the tendon sheath be differentiated from ganglionic cysts?

Answer 15

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)

Question 16

How is a lipoma differentiated from a ganglionic cyst?

Answer 16

It will not be entirely spherical, and does not transilluminate

Question 17

How is osteoarthritis differentiated from a ganglionic cyst?

Answer 17

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

Question 18

How is sarcoma differentiated from a ganglionic cyst?

Answer 18

Typically not well circumscribed or mobile lesions

Question 19

How are most ganglionic cysts diagnosed?

Answer 19

Clinically

Question 20

How might a plain film radiograph be useful in ganglionic cysts?

Answer 20

May assist in ruling out osteoarthritis or bone malignancies as diffentials, as ganglions cannot be visualised via x-ray

Question 21

What investigations can be done in uncertain cases of ganglionic cysts?

Answer 21

Imaging via ultrasound or MRI

Question 22

What is the purpose of ultrasound or MRI imaging in ganglionic cysts?

Answer 22

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

Question 23

What is the purpose of aspiration of ganglionic cysts?

Answer 23

• Temporary symptomatic relief
• Assessment of extracted fluid with microscopy +/- cytology

Question 24

What is the limitation of aspiration of ganglionic cysts for symptomatic relief?

Answer 24

There is a high rate of recurrence

Question 25

How is a ganglionic cyst managed if it is not causing pain?

Answer 25

The usual recommendation is to monitor

Question 26

Why is the recommendation to monitor if the ganglionic cyst is not causing pain?

Answer 26

Because cysts often disappear spontaneously without further intervention

Question 27

How are ganglionic cysts managed if they cause pain or severely limit the range of movement?

Answer 27

There are two main interventions;

• Aspiration, with or wihtout steroid injection
• Cyst excision

Question 28

What is the problem with aspiration in ganglionic cysts?

Answer 28

It is associated with infection and high rate of recurrence

Question 29

What is the limitation of steroid injections in ganglionic cysts?

Answer 29

There it limited evidence demonstrating a clear benefit of steroid injections in the ganglion

Question 30

What does cyst excision involve in ganglionic cysts?

Answer 30

Removing the cyst capsule along with a portion of the associated tendon sheath

Question 31

Can recurrence occur with cyst excision?

Answer 31

Yes, but recurrence is less than with aspiration

Question 32

What is cyst excision often reserved for?

Answer 32

Symptomatic cases with recurrence following aspiration