Ganglion (synovial) cysts are a cystic swelling overlying a joint or tendon sheath. They are the most common soft-tissue tumors of the hand and wrist, although they can arise over any joint. The etiology is currently debated; the most commonly accepted theory is the cyst forms secondary to mucoid degeneration of collagen and connective tissues. It is unclear whether repetitive motion leads to causation, although it does appear to provoke symptoms and possibly lead to cyst enlargement. They may occur in any age, although the majority arise between the 2nd and 4th decades of life.
Ganglion cysts are composed of collagen fiber walls with clear, highly viscous mucin content. They may be unilocular or multilocular. The most common presentations include swelling over or near a joint, as well as pain, limitation of motion, weakness, and paresthesias. They are rarely greater than 2 cm in diameter. The most common location is dorsally over the scapholunate ligament of the wrist (60%-70%), with the volar wrist the next most common site (20%).
Management and Disposition
Ganglion cysts may spontaneously regress; therefore, treatment is generally reserved for symptomatic lesions. Treatments include both nonsurgical and surgical options. The most common nonsurgical option is cyst aspiration, generally using a 16-gauge needle, followed by steroid injection. For recurrent lesions, referral to a hand surgeon for excision is warranted.
Ganglion Cyst. This large ganglion cyst is located over the scapholunate ligament, the most common location for this entity. (Photo contributor: Lawrence B. Stack, MD.)
Patients with chronic dorsal wrist pain of unknown etiology should be screened for occult ganglion cysts.
MRI or ultrasound may be useful in detecting occult ganglion cysts.
Never aspirate volar cysts due to the high risk of injury to neurovascular structures.
Ganglion Cyst. Classic example of a ganglion cyst located over the scapholunate ligament of the wrist. (Photo contributor: Lawrence B. Stack, MD.)