Ganglion cyst

Pathophysiology

• Fluid-filled swelling overlying a joint or tendon sheath
• Thought to arise from a herniation of dense connective tissue
• Contain thick gelatinous fluid
• 70% from dorsal wrist (mostly from radiolunate ligament)
• 20% from volar wrist over scaphotrapezoid ligament
• Others over A1 pulley
• Digital mucous cyst is a ganglion that forms over dorsal DIPJ - these ones are usually a/w osteoarthritis
• But can technically occur pretty much anywhere on the body

Diagnosis

• Should transilluminate
• USS can add clarity if in doubt
• MRI is very good at diagnosis if still in doubt

Differential

• Tenosynovial giant cell tumour
• Epidermoid cyst
• Lipoma
• Infectious tenosynovitis
• Rheumatoid nodule
• Tendinous xanthoma
• Tophus
• Synovial sarcoma

Treatment

Aspiration - worth trying, although 50% recur

• 18G needle

Injection with steroids - UTD says not worthwhile

Surgery

• Persistent or recurrent symptoms despite initial conservative management
• 10% recur