Ganglion Flashcards
What is a ganglionic cyst? Where are they most commonly seen?
Non cancerous soft-tissue lump arising from a joint or tendon sheath. Arise from degeneration within the joint capsule or tendon sheath, filling with synovial fluid.
Most commonly seen around the back of the wrist
What are the risk factors for ganglionic cysts
Female
Osteoarthritis can cause an increase of fluid in the joint
Previous joint or tendon injury
What are the clinical features of ganglions
Smooth spherical painless lump adjacent to joint affected.
May appear suddenly or grow over time
Will transilluminate
May mechanically restrict the full range of motion
Local paraesthesia, pain or motor weakness if it exerts any pressure upon adjacent nerves
What are the Ddx for ganglion?
Tenosynovitis - swelling along tendon, no discrete mass
Giant cell tumour of tendon sheath - mass is solid, does no transluminate and is fixed to the underlying sheath - less mobile than ganglionic cyst
Lipoma - not entirely spherical and does not transilluminate
Osteoarthritis - accompanied from a long standing OA of the scaphotrapeziotrapezoid joint presenting as a palpable hard, non-cystic and immobile mass that does not transilluminate
Sarcoma - typically not well circumscribed or mobile
What investigations for ganglion?
Clinical diagnosis
Plain radiograph may help to rule out osteoarthritis or bone malignancy
Ultrasound/MRI in uncertain cases to assess the shape, size and depth o the cyst
How is a ganglionic cyst managed?
If painless, monitor as cysts often disappear spontaneously
If painful or limits range of movement:
Aspiration ± steroid injection
Cyst excision - removal of cyst capsule with a portion of the associated tendon sheath
