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. These are usually not necessary.
- 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.
- Inform patient that recurrence rate after surgical excision of a ganglion cyst is 5 to 10 percent.
- 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 only needs to be made if the patient indicates that they want it surgically removed – if they don’t want surgery, we don’t need to see them.
Criteria for Return to Primary Care
- Successful surgical treatment or refusal of surgical treatment.
