Ganglionic Cysts Flashcards
What are ganglionic cysts?
Non-cancerous soft tissue lumps that occur along any joint or tendon.
Arise from degen within joint capsule or tendon sheath.
They then become filled with synovial fluid.
Where are ganglionic cysts most commonly found?
Around hands and feet with 60-70% of ganglions appearing on the dorsal aspect of the wrist
Epidemiology
More common in women
20-40 yo
Risk factors
Female
OA -> increase of fluid in joint -> leakage to tendon sheath into cyst
Previous joint or tendon injury
Clinical features
Smooth spherical painless lump adjacent to the affected joint
Can come on suddenly or insidiously grow.
The cyst can even disappear and reappear
Examination findings
Soft + transilluminate
Can mechanically restrict full range of motion
Additional symptoms that can occur
The cyst can put pressure on adjacent nerve and produce associated symptoms of nerve compression
Dx
Tenosynovitis
Giant cell tumour of tendon sheath (does not transilluminate and is fixed)
Lipoma (does not transilluminate)
OA (hard mass)
Sarcoma (not well circumscribed or mobile)
Ix
Diagnosed clinically
X-ray can be done to rule out OA, malignancy or any other differentials
USS or MRI can be done to assess shape, size and depth if there is uncertainty
Aspiration can be done for temporary symptomatic relief and fluid sent for microscopy and cytology if indicated
X-ray findings
Ganglions cannot be seen on x-ray
Management
Usually only monitoring is done as they disappear spontaneously most commonly
Indications for further management
Pain or severely limits range of movement
Further management
Aspiration +/- steroid injection (this can however cause infection and has a high rate of recurrence)
Cyst excision to remove the cyst capsule + a part of the associated tendon sheath (this has a lower recurrence rate) and is usually only done if there is recurrence following aspiration.
