Ganglion

What is it?

Ganglion cysts are the commonest type of swelling in the hand and wrist. They contain a thick clear fluid and can arise a variety of structures but there are four common locations in the hand and wrist - in the middle of the back of the wrist (from the scapholunate ligament), on the front of the wrist at the base of the thumb (from the wrist joint), at the base of a finger on the palmar side (from the tendon sheath), and on the back of an end joint of a finger (from the end joint).

What is the cause?

Most ganglion cysts arise spontaneously but occasionally there is a history of injury or the joint is starting to develop arthritis.

What are the symptoms?

A swelling becomes noticeable and it may or may not be painful.

How is the diagnosis made?

The diagnosis is usually straightforward as ganglion cysts tend to be smooth and round, fluctuate in size and occur at characteristic locations in the hand and wrist. If the diagnosis is uncertain then scans may be helpful.

What is the treatment?

Ganglion cysts are harmless and can safely be left alone. Many disappear spontaneously and many others cause little trouble. There are no long term consequences from leaving the ganglion untreated.

Who to refer, who not to refer, how to refer

Who to Refer

Diagnostic difficulties
Persistently large and symptomatic
Small but very painful ( commonly flexor sheath)
Compressive sx (neurological)

Urgent Referral Criteria

Nil/ Suspicious Lumps

Who Not to Refer

Straight forward dx with cosmetic but no/ mild functional problems

Additional Info

Clinical examination of joint - palpation of lump (fluctuant or firm?), range of movement of affected joint?
Aspiration of cyst may confirm diagnosis and be successful treatment in 50%
Need to be very clear that surgery is limited- only for large ganglions which limited function

Imaging