Orthopedics - Ganglions
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- 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
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
- 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
- Surgical removal of a
ganglion cyst is a low risk low morbidity procedure done electively at the
- 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.