Ganglion cysts are one of the most common benign soft tissue masses affecting the hand and wrist, originating from the synovial lining of joints and tendons. 

   

Aetiology

  • The most common cause of lumps on the hand and wrist, originating from the synovial lining of joints and tendons, which produces lubricating fluid.
  • These cysts are typically pulsion diverticulae - herniation of the synovium.
  • The exact cause is unknown.
  • Myxoid or mucous cysts are a sub-type of ganglion, commonly associated with arthritis. They are commonly present around the proximal nail fold. A clear fluid may be expressed. 
A ganglion cyst
Figure 170: Ganglion cyst. User:GEMalone, Cyst Profile2, CC BY 3.0

Clinical features

  • Usually asymptomatic unless large enough to exert pressure or impair joint function.
  • On examination, they are smooth swellings, often found:
    • On the back or front of the wrist, base of the fingers or back of the fingers near the joints.
  • They transilluminate, reflecting their fluid contents, which helps differentiate them from other types of lump. 
Ganglion cyst
Figure 171: Ganglion-cyst, Esturcke at English Wikipedia, CC BY-SA 3.0

Management

  • Treatment is generally only recommended by if the cyst is causing significant pain or affecting the range of movement of a joint.
  • They often resolve without intervention.
  • If required, management options include:
    • Aspiration - high recurrence rate.
    • Surgery: Open surgery or arthroscopic removal of the cyst.