Wrist & Hand: Ganglionic Cyst

Question 1

what are ganglionic cysts

Answer 1

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

Question 2

what causes a ganglionic cyst

Answer 2

arise from degeneration within the joint capsule or tendon sheath of the joint, subsequently becoming filled with synovial fluid

Question 3

where are they most commonly found

Answer 3

hands and feet

60-70% of ganglions appearing on the dorsal aspect of the wrist

Question 4

are they more common in men or women?

Answer 4

women - peak age of onset 20-40 years old

Question 5

risk factors for ganglionic cyst

Answer 5

female
OA
previous joint or tendon injury

Question 6

clinical features

Answer 6

smooth spherical painless lump adjacent to the affected joint
may appear suddenly or slowly overtime

Question 7

on examination of a ganglionic cyst

Answer 7

lump will be soft and will transilluminate

may mechanically restrict the full ROM in the affected joint

Question 8

what happens if the cyst exerts pressure on an adjacent nerve

Answer 8

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

Question 9

DDx for ganglionic cyst

Answer 9

tenosynovitis - no discrete mass - swelling tracking along the tendon
giant call tumour of tendon sheath - mass is solid, doesn’t transluminate and is fixed to the underlying sheath
lipoma - not entirely spherical and dose not trans-illuminate
OA - usually accompanied from a long standing OA of the scaphotrapeziotrapezoid joint, presenting as a hard palpable, hard, non-cystic, and immobile mass that does not trans-illuminate
sarcoma - typically are not well circumscribed or mobile lesions

Question 10

how are ganglionic cycts diagnosed?

Answer 10

usually diagnosed clinically - plain radiograph may be used to help rule out OA or bone malignancies
uncertain cases - USS, MIR assess shape, size, depth

Question 11

how are ganglionic cysts managed?

Answer 11

not causing pain - monitor as often they disappear spontaneously without intervention
aspirated for temporary symptomatic relief - high rate of recurrence
fluid can be extracted and sent off for microscopy +/_ cytology if required
can be given steroid injection - associated with infection though
cyst excision - removing cyst capsule along with portion of associated tendon sheath (often reserved for symptomatic cases with recurrence following aspiration)