Makindo Medical Notes

Overview of Ganglion Cysts

Ganglion cysts are non-cancerous lumps or swellings that typically develop along the tendons or joints of the wrists or hands, but can also appear in the ankles, feet, or other joints. These cysts are filled with a jelly-like fluid and are the most common soft-tissue lesions of the hand.

Etiology

Ganglion cysts arise from the degeneration of the connective tissue around joints and tendons, but the exact cause is unclear. Contributing factors include:

• Repetitive use or trauma: Overuse or repeated stress on a joint or tendon.
• Joint or tendon irritation: Degeneration of joint tissues leading to cyst formation.
• Synovial herniation: Cysts may develop due to herniation of the synovial membrane.

Clinical Presentation

• Appearance:
  • Ganglion cysts are smooth, rounded, and firm lumps beneath the skin.
  • They may be translucent and range in size from a pea to a golf ball.
• Location: Most commonly occur on the dorsal or volar side of the wrist but may also appear on the fingers, palm, or foot.
• Symptoms:
  • Often asymptomatic but can cause discomfort if compressing surrounding nerves or tissues.
  • Pain may worsen with joint activity, and weakness or limited range of motion can occur.
• Consistency: Typically soft or rubbery but can sometimes be firm.

Types of Ganglion Cysts

• Dorsal Wrist Ganglion: Located on the back of the wrist; the most common type of ganglion cyst.
• Volar Wrist Ganglion: Located on the palm side of the wrist; may involve the radial artery.
• Flexor Sheath Ganglion: Occurs at the base of a finger and can cause pain with movement.
• Mucous Cyst: Occurs over the distal interphalangeal (DIP) joint of the fingers, often associated with osteoarthritis.

Diagnosis

Ganglion cysts are usually diagnosed clinically. Additional diagnostic tools include:

• Transillumination: Shining a light through the cyst can help differentiate it from a solid mass.
• Ultrasound: Can confirm the cystic nature and its relation to surrounding structures.
• MRI or X-rays: Used to rule out underlying joint pathology or for preoperative planning.

Differential Diagnosis

• Lipoma
• Epidermoid cyst
• Gouty tophus
• Rheumatoid nodule
• Synovial sarcoma (rare)

Management

• Conservative Treatment:
  • Observation: Many ganglion cysts are asymptomatic and may resolve spontaneously without treatment.
  • Immobilization: Splinting or bracing the joint can reduce fluid accumulation and shrink the cyst.
  • Aspiration: Using a needle to drain the cyst's fluid, though recurrence is common after aspiration.
  • Corticosteroid Injection: Reduces inflammation and may prevent cyst recurrence after aspiration.
• Surgical Treatment:
  • Excision (Ganglionectomy): Surgical removal of the cyst, along with its stalk. Lower recurrence rate but more invasive.
  • Arthroscopic Surgery: Minimally invasive technique for cyst removal, often used for wrist ganglions.

Complications

• Recurrence: Ganglion cysts frequently recur, especially after non-surgical treatments such as aspiration.
• Nerve Compression: Large cysts may compress nearby nerves, causing pain, tingling, or weakness.
• Infection: Rare but possible after aspiration or surgery.

Patient Education

• Activity Modification: Advise patients to avoid repetitive movements or stress on the joint or tendon.
• Prognosis: Most ganglion cysts are benign and may resolve spontaneously, but recurrence is common.

Follow-up

Patients with recurrent or symptomatic cysts may require follow-up for potential surgical intervention. Post-surgical follow-up is important to monitor for recurrence or complications.

Summary

Ganglion cysts are common, benign, and usually asymptomatic soft tissue lesions. Conservative treatments such as observation, aspiration, or immobilization are often sufficient, while surgical excision is reserved for recurrent or symptomatic cases. The prognosis is generally good, but recurrence is common after non-surgical treatments.