Ganglion Cyst (Exam 4)

Question 1

Ganglion Cysts

Answer 1

Common lumps within the hand and wrist that occur adjacent to joints or tendons

Typically fluid filled but can have lumps and bumps made of fat (lycomas)

The most common locations are: 
 top of the wrist
 palm side of the wrist (FCR and FCU)
 base of the finger on the palm side
 top of the end joint of the finger (DIP)

Tendon cysts - come from tendon sheath
Joint cysts - come from joint capsule
Dorsal wrist ganglion - come from scapholunate joint
(gymnast, athletes, crossfit)
small tear in capsule btwn
scapholunate bones and fills with
fluid

Question 2

S/S

Answer 2

The ganglion cyst often resembles a water balloon on a stalk, and is filled with clear fluid or gel

It arises from a joint capsule or tendon sheath

The stalk can wrap around Nn and cause compression symptoms

Until you can see the cyst, pt may present like CT, you must palpate and know what to look for, flex wrist and look for bump

Question 3

Pathology/Etiology

Answer 3

• The cause of these cysts is unknown
  
  • joint or tendon irritation
  • mechanical changes
• They can occur in pt of all ages
• These cysts may change in size or even disappear completely, and they may or may not be painful
• Ganglion cysts are not cancerous and will not spread to other areas, they should be mobile

Question 4

Treatment

Answer 4

• Observe and wait
• Needle aspiration followed by compression, but
  reoccurrence is common
• Aspiration and cortisone - inject needle and pull fluid out
  but high chance that dorsal wrist gang will return b/c
  they have to fix the leak in the capsule
• Splinting to rest the irritated tissue
• Smash it with a book - can cause damage to other
  tissues - NOT RECOMMENDED!!

Question 5

Surgical Intervention

Answer 5

Once you have tried everything else

• Surgery involves removing the cyst along with a portion
  of the joint capsule or tendon sheath
• Best results if the sheath or joint capsule is sutured
  closed
• In the case of the wrist ganglion cysts, both traditional
  open and arthroscopic techniques usually yield good
  results
• Surgical treatment is generally successful although cyst
  may recur

Question 6

Post Op

Answer 6

• Depends on the surgeon and location of cyst
• AROM starts day 5 - like to rest first 5 days b/c it was
  inflammatory
• ROM exercises and scar massage - start as soon as scar
  is healed enough to tolerate it
• Some form of compression used for up to 12 weeks -
  bandage so it does not fill back up