Ganglion cyst

Question 1

Define ganglion cyst.

Answer 1

Ganglion cysts are smooth, soft, benign masses that are usually located on the wrist (dorsal or volar aspect) with one or more communicating stalks into the wrist joint or surrounding structures. They can be single or multi-loculated and are filled with viscous, sticky, mucinous fluid.

Question 2

What is the most common type of tumour of the hand and wrist?

Answer 2

Ganglion cysts

Question 3

Who is more likely to get ganglion cysts? Where are they usually located?

Answer 3

F>M 3:1

Dorsal wrist> volar wrist

Question 4

What is the aetiology of ganglion cysts?

Answer 4

Traumatic

Non-traumatic

• Hole in wrist capsule
• Tumours
• Synovial fluid leakage
• Mucoid degeneration of collagen

Question 5

What are the clinical features of ganglion cysts?

Answer 5

• Subcutaneous wrist mass -
  
  • up to 8cm in size
  • smooth and slightly mobile with no connections to underlying tendons
• Wrist pain
• Non-tender mass
• Increased mass size after activity
• Trans-illuminating mass
  
  • typical reddish glow of a fluid-filled cyst

Question 6

How are ganglion cysts diagnosed?

Answer 6

Clinically

Question 7

What is the management of ganglion cysts?

Answer 7

• Observe
• Activity modification +/- analgesia
• Cyst aspiration and corticosteroid injection
  
  • not recommended for volar cysts as there is risk of radial artery damage
• Surgical resection - open or arthroscopic

Question 8

What is the prognosis with gangion cysts?

Answer 8

Dorsal ganglia have a 3% to 9% recurrence rate and volar ganglia have a recurrence rate of 7% to 19%. Open surgical excision offers a significantly lower chance of recurrence compared with aspiration

Observation is usually sufficient as 58-93% will self-resolve

No reported cases of malignant degeneration