Ganglion Cysts

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Patient Information

GP Information

Background Information

  • 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.

Investigation Guidelines

  • Diagnosis is typically clinical but USS is indicated in cases of diagnostic uncertainty.

Management Recommendations

  • 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.