🖐️ Ganglion cysts are benign, non-cancerous swellings arising near tendons or joints, most often on the wrist or hand. They contain a jelly-like synovial fluid. They are the most common soft-tissue lesion of the hand and can fluctuate in size.

🔎 Etiology

The exact cause is unclear, but they likely arise from degeneration or herniation of synovial tissue. Risk factors:

🔁 Repetitive use / trauma: Overuse or repeated micro-injury.
⚡ Joint or tendon irritation: Chronic stress on capsule or tendon sheath.
🫧 Synovial herniation: Fluid outpouching through joint capsule.

🩺 Clinical Presentation

Appearance: Smooth, rounded, firm or rubbery lump under skin; often translucent. Size: pea → golf ball.
Location: Common on dorsal wrist; also volar wrist (⚠️ close to radial artery), fingers, palm, or foot.
Symptoms: Frequently painless, but may cause discomfort, aching, or weakness if compressing nerves. Worse with activity.
Exam tip 💡: They move with the tendon sheath or joint capsule, not freely mobile like lipomas.

📍 Types of Ganglion Cysts

Dorsal Wrist Ganglion: Back of wrist; most common.
Volar Wrist Ganglion: Palm side; may involve radial artery (care in aspiration!).
Flexor Sheath Ganglion: Base of finger; causes pain with grip.
Mucous Cyst: Over DIP joint; often with OA & nail ridging.

🧾 Diagnosis

Usually clinical. Supportive tests include:

💡 Transillumination: Fluid-filled cyst glows.
🩻 Ultrasound: Confirms cystic nature, relation to tendon/joint.
🧲 MRI/X-ray: Exclude intra-articular pathology, OA, or pre-op planning.

🔀 Differential Diagnosis

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

💊 Management

Conservative:
- 👀 Observation: Many resolve spontaneously.
- 🩹 Immobilisation: Splinting reduces fluid pressure.
- 💉 Aspiration: Simple, but recurrence up to 70%.
- 🌡️ Steroid injection: May reduce recurrence post-aspiration.
Surgical:
- 🔪 Excision (ganglionectomy): Removes cyst + stalk; recurrence ~10–20%.
- 🔍 Arthroscopic removal: Minimally invasive option, esp. wrist.

⚠️ Complications

♻️ Recurrence: Common after aspiration; less with excision.
🧠 Nerve compression: Median or radial nerve irritation ➝ paraesthesia, weakness.
🦠 Infection: Rare post-aspiration or surgery.
💥 Historical note: "Bible therapy" (smashing cyst with a book) - no longer recommended!

📚 Patient Education

🧘 Activity modification: Avoid repetitive wrist stress.
📉 Prognosis: Benign, but recurrence common.
⚕️ When to seek review: Rapid growth, persistent pain, neuro symptoms, or recurrent cysts.

📅 Follow-up

Monitor asymptomatic cysts. Refer for surgery if recurrent, painful, or functionally limiting. Post-op follow-up to detect recurrence or infection.

✅ Summary

Ganglion cysts are common, benign swellings arising from joints/tendons. Most are harmless, with treatment ranging from observation → aspiration → excision. Surgery has lower recurrence, but conservative care is often sufficient. Prognosis is excellent. 🌟

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Ganglion Cysts