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  • Ganglion cysts arise from joint capsules or tendon sheaths.
  • They are the most common benign soft tissue tumor of the hand and wrist.
  • They are filled with inspissated fluid.

Initial Diagnosis and Management

  • The anatomical location of ganglion cysts in descending order of frequency is:
    • dorsal wrist
    • radiopalmar wrist, and
    • arising from the annular pulley at the palmodigital crease.
  • The history is of an enlarging mass that may vary over time and with activity.  Complaints including aching or pain with wrist or digital motion.
  • Examination reveals a palpable mass which is usually soft but occasionally firm.  The masses are variably tender to direct pressure.
  • Additional diagnostic tests include transillumination (digital ganglions usually do not transilluminate), aspiration or ultrasound.
  • Initial management may be observation only, splinting to relieve acute discomfort or aspiration.
  • Aspiration of radiovolar wrist ganglions may entail significant hazards and is not recommended.

Ongoing Management and Objectives

  • The objective of initial management is resolution of symptoms, not necessarily disappearance of the cyst.
  • Aspiration frequently results in recurrence.
  • More definitive treatment need not be undertaken if the cyst is asymptomatic.

Indications for Specialty Care Referral

  • Failure to achieve a cosmetically and/or clinically acceptable result with non-surgical management.
  • Surgical removal of a ganglion cyst is a low risk low morbidity procedure done electively at the patient's request.
  • Referral to hand surgery should be for surgical treatment.

Criteria for Return to Primary Care

  • Successful surgical treatment or refusal of surgical treatment.
  • Recurrence rate after surgical excision of a ganglion cyst is 5 to 10 percent.
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