II. Epidemiology
- Most common Soft Tissue Mass in the hand
- Adults affected most commonly
- Peak ages
- Adults age 20 to 40 years old are most commonly affected
- Young children may be affected
- Subsides by age 2 to 3 years in most cases
III. Pathophysiology
- Cyst is an outpouching of the synovial joint capsule and contains mucinous material
- Stalk attaches cyst to tendon sheath or joint
IV. Findings
- Freely movable mass over joint or tendon
- Ganglion Cysts are typically painless, fluid-filled masses
- Transillumination or Bedside Ultrasound can confirm fluid-filled mass
- Local pain or weakness
- Occult Ganglion Cyst may cause regional pain (e.g. dorsal Wrist Pain)
- Ganglion may be hidden by overlying extensor tendon
- Distribution
- Hand and Wrist
- Dorsal wrist most commonly affected (esp. near scapholunate joint, 70% of cases)
- Ganglion Cyst more prominent with wrist flexed
- Volar wrist (20% of cases)
- Digital flexor tendon
- Digital Mucous Cyst (DIP Joints)
- Dorsal wrist most commonly affected (esp. near scapholunate joint, 70% of cases)
- Other, less common, Non-wrist sites
- Hand and Wrist
V. Management
- Ganglion Cyst Aspiration
- Compression dressing applied for 48 to 72 hours
- Consider Splinting wrist for several days
- Indications for Surgical excision of Ganglion Cyst
- Symptoms persist
- Despite aspiration and steroid injection 1 to 2 times
VI. Course
- Spontaneous resolution without treatment: 53%
- Recurrence within 2 to 5 years after treatment
- Recurrence after surgical excision: 42%
- Recurrence after aspiration: 47%
- References