Ganglion

Notes

Overview

A ganglion cyst is a fluid-filled swelling the occurs over a joint or tendon sheath.

Ganglions are fluid-filled swellings known as cysts that are commonly observed in the hand or wrist. They usually occur over a joint or tendon sheath. They can occur at all ages but usually occur in the second to fourth decades. They are a very common cause of swelling in the hand and wrist.

Ganglion wrist

Aetiology & pathophysiology

Ganglions contain mucinous, gelatinous fluid.

Ganglions are thought to arise from the herniation of connective tissue around key musculoskeletal structures such as tendon sheaths, ligaments, joint capsules, and bursae. This is thought to occur due to mucoid degeneration of these structures. There may be a history of trauma but most ganglions occur spontaneously.

There are four common locations for ganglions in the hand and wrist:

  • Back of the wrist (middle)
  • Base of the thumb (front)
  • Base of a finger (palm)
  • End of a finger joint (dorsum)

Clinical features

Patients usually present with an obvious swelling in the hand or wrist.

A ganglion cyst usually presents as a noticeable swelling in the hand or wrist. It may be painless or painful with the pain precipitated by movement. On examination, the cyst may feel firm, smooth, rubbery, or rounded. If the cyst is large enough it should transilluminate (i.e. allow light to pass through). The actual size of the cyst may change over time.

Ganglion 2

Diagnosis & investigations

The diagnosis of a ganglion is made based on clinical examination.

The presence of a smooth, fluctuating swelling in a characteristic location on the hand or wrist is usually enough to make the diagnosis. If the diagnosis is unclear, an ultrasound or MRI may be used to confirm the diagnosis.

Management

It is estimated that >50% of case swill spontaneously resolve.

The majority of ganglions will spontaneously resolve and do not require intervention. If the cyst is causing significant pain that limits activity then surgical intervention is warranted. Options include:

  • Ganglion cyst aspiration: high risk of recurrence within one year
  • Surgical excision

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