- Ganglia are common benign soft tissue tumors of the hand and wrist.
- Wrist ganglia are commonly found on the dorsal (scapholunate joint) or volar (radiocarpal / STT joint) surfaces.
- Finger ganglia are commonly found on the palmar aspect originating from the flexor sheath or dorsally at the DIPJ associated with osteoarthritis.
- DDx include; Extensor tenosynovitis, Radial artery aneurysm (volar wrist) and soft tissue tumours.
- Patients typically complain of painless/painful lumps typically without a precipitating event.
- Examination may reveal a palpable lump not fixed to the skin.
- Diagnosis is typically clinical but USS is indicated in cases of diagnostic uncertainty.
- 50% of ganglia will resolve within 2 yr (80% 1 yr in chidren).
- Treatment for cosmesis is not advised and should be reserved for painful ganglia with functional compromise or diagnostic uncertainty.
- 1st line management consists of explanation and advice, with reassurance and observation.
- Symptomatic dorsal wrist ganglia may be safely aspirated in the community but advise up to 80% recurrence rates.
- Symptomatic volar wrist ganglia can be aspirated under image guidance but there is increased risk of neurological damage.
- Referral indications: Diagnostic uncertainty, severe pain or loss of function. Large symptomatic mucous cyst with / without recurrent discharge, • Results of diagnostics indicate specialist assessment required.