Ganglions

Diagnosis/Definition

• 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.