Ganglion Cyst

A ganglion cyst is a benign, fluid-filled swelling arising from a joint capsule or tendon sheath, and it is the commonest swelling of the hand and wrist.

Dorsal wrist ganglia typically occur in young adults. Many disappear without treatment, and leaving a ganglion untreated has no long-term consequences.

Treatment is driven by pain, function, appearance or diagnostic doubt, not by the cyst itself. Recurrence is common after aspiration and still occurs after surgery.

A ganglion has a wall of compressed connective tissue without a true synovial lining and contains thick, clear fluid rich in hyaluronic acid. A stalk usually connects it to the joint or tendon sheath and can act as a one-way valve, so the cyst changes size with activity.

There are 4 common sites (BSSH):

• •Dorsal wrist ganglion: the commonest, from the scapholunate ligament
• •Volar wrist ganglion: at the base of the thumb, from the wrist joint, close to the radial artery; in older people it may accompany wrist arthritis
• •Flexor tendon sheath ganglion: a pea-sized firm lump at the base of a finger on the palmar side
• •Mucous cyst: on the back of the end joint of a finger, with early distal interphalangeal (DIP) osteoarthritis; pressure may groove the nail

Most arise spontaneously; occasionally there is a history of injury or early arthritis in the joint.