Ganglion Cyst

Overview

what it is and why it matters

Palmar dissection of the hand and wrist showing the eight carpal bones, flexor tendons, and median and ulnar nerves. — **Hand and wrist anatomy.** Eight small carpal bones form the wrist and connect the forearm to the five metacarpals of the palm. Finger tendons and the median and ulnar nerves pass through narrow tunnels in the wrist on their way into the hand.

A ganglion cyst is the most common soft-tissue mass in the hand and wrist. It is a benign, fluid-filled sac that arises from a joint capsule or tendon sheath — most often the dorsal wrist at the scapholunate ligament, the volar wrist near the radial artery, or the dorsal DIP joint (where it is called a mucous cyst). The fluid inside is viscous and jelly-like, similar to joint fluid but more concentrated.

Many ganglions are asymptomatic; others cause a visible lump, aching with wrist use, or nerve compression symptoms. They often fluctuate in size and may spontaneously resolve.

Diagnosis

exam first, imaging second

Diagnosis is clinical: a smooth, firm, transilluminable mass in a characteristic location. Ultrasound confirms cystic nature and can show the stalk connecting the cyst to the underlying joint. MRI is ordered when the diagnosis is uncertain or when an occult ganglion is suspected as the cause of unexplained wrist pain. X-rays assess for underlying arthritis or bony pathology.

Treatment Path

how care progresses at OSI

Observation

Asymptomatic ganglions may resolve spontaneously; watchful waiting is a reasonable first approach.

Aspiration

Needle aspiration under ultrasound guidance can decompress the cyst. Recurrence rate is ~50%, but aspiration may be repeated or may achieve lasting resolution.

Surgical Options at OSI

if non-operative care isn't enough

Surgical excision is offered for symptomatic cysts failing aspiration, recurrent cysts, or when nerve or vessel compression is present.

Overview

Diagnosis

Treatment Path

Observation

Aspiration

Surgical Options at OSI

Providers Who Treat Ganglion Cyst

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Further Reading

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