Wrist

Ganglion Cyst

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Ganglion Cyst, Synovial Cyst

  • See Also
  1. Ganglion Cyst Aspiration
  2. Soft Tissue Mass
  • Epidemiology
  1. Most common Soft Tissue Mass in the hand
  2. Adults affected most commonly
  3. Peak ages
    1. Adults age 20 to 40 years old are most commonly affected
    2. Young children may be affected
      1. Subsides by age 2 to 3 years in most cases
  • Pathophysiology
  1. Cyst is an outpouching of the synovial joint capsule and contains mucinous material
  2. Stalk attaches cyst to tendon sheath or joint
  • Findings
  1. Freely movable mass over joint or tendon
  2. Ganglion Cysts are typically painless, fluid-filled masses
    1. Transillumination or Bedside Ultrasound can confirm fluid-filled mass
  3. Local pain or weakness
    1. Occult Ganglion Cyst may cause regional pain (e.g. dorsal Wrist Pain)
    2. Ganglion may be hidden by overlying extensor tendon
  4. Distribution
    1. Hand and Wrist
      1. Dorsal wrist most commonly affected (esp. near scapholunate joint, 70% of cases)
        1. Ganglion Cyst more prominent with wrist flexed
      2. Volar wrist (20% of cases)
      3. Digital flexor tendon
      4. Digital Mucous Cyst (DIP Joints)
    2. Other, less common, Non-wrist sites
      1. Foot
      2. Knee
      3. Shoulder
      4. Spine
  • Management
  1. Ganglion Cyst Aspiration
  2. Compression dressing applied for 48 to 72 hours
  3. Consider Splinting wrist for several days
  4. Indications for Surgical excision of Ganglion Cyst
    1. Symptoms persist
    2. Despite aspiration and steroid injection 1 to 2 times
  • Course
  1. Spontaneous resolution without treatment: 53%
  2. Recurrence within 2 to 5 years after treatment
    1. Recurrence after surgical excision: 42%
    2. Recurrence after aspiration: 47%
  3. References
    1. Dias (2003) J Hand Surg 28:172-6 [PubMed]
  • References
  1. Pujalte (2024) Am Fam Physician 110(4): 402-10 [PubMed]