Ganglion cysts of the wrist and hand
- Filip De Keyser, MD, PhD
Filip De Keyser, MD, PhD
- Professor of Rheumatology
- Ghent University
A ganglion cyst is one of the most common soft tissue swellings in the hand and wrist. Although ganglion cysts are benign lesions, they may lead to pain, weakness, and loss of function, and sometimes require treatment.
The presentation, diagnosis, differential diagnosis, and treatment of ganglion cysts of the wrist and hand will be discussed here. The evaluation of the adult with hand or wrist pain are discussed separately. (See "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "History and examination of the adult with hand pain".)
A ganglion cyst is a fluid-filled swelling overlying a joint or tendon sheath. Ganglion cysts are thought to arise from a herniation of dense connective tissue from tendon sheaths, ligaments, joint capsules, bursae, and menisci. They contain a mucinous, gelatinous fluid.
The most common location for ganglion cysts is the dorsal side of the wrist (70 percent) (picture 1) . Most of the dorsal wrist ganglions can be traced by their stalk as originating from the radiolunate ligament . The cysts can be unilocular or multilocular. The second most common location for ganglion cysts in the hand is the volar side of the wrist (20 percent) over the scaphotrapezoid joint. Ganglions can also arise from the digital flexor tendon sheath, which has classically been described as arising from the first annular (A1) pulley (figure 1) of the fingers. A small mass may be palpable in the flexion crease at the base of the finger.
A digital mucous (or mucinous) cyst is a ganglion cyst that forms over the dorsal side of the distal interphalangeal (DIP) joint . They occur most commonly in the fifth to seventh decades and are usually associated with an underlying diagnosis of osteoarthritis.
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- DIFFERENTIAL DIAGNOSIS
- Tenosynovial giant cell tumor
- Epidermoid cysts
- Infectious tenosynovitis
- Rheumatoid nodules
- Tendinous xanthoma
- Synovial sarcoma
- Ganglion cyst aspiration
- Surgical therapy
- Ineffective therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS