GANGLION OF WRIST
A ganglion is a cystic
lesion that is found closely associated with a joint capsule or tendon sheath. It
is often seen in young adults but rarely in children; most frequently, it forms
in the hand and wrist and less often in the ankle, foot, and knee. The most
common site is the dorsum of the wrist just lateral to the common extensor
tendons of the fingers. A ganglion usually occurs singly and may be
multilocular; it consists of an outer fibrous coat and an inner synovial lining
and contains a clear, colorless, gelatinous fluid.
Although the cause is uncertain,
perhaps the most accepted theory is that a ganglion results from cystic
degeneration of connective tissue near joints or tendon sheaths. Repeated
trauma appears to be a causative factor in about 50% of cases.
CLINICAL MANIFESTATIONS
The only finding may be a slowly
growing, localized swelling, but most patients report intermittent aching and
mild weakness. Commonly, the patient will describe the mass waxing and waning
in size and may have short-term resolution after “bumping” the mass
inadvertently.
On examination, the cyst is firm,
smooth, rubbery, rounded, slightly fluctuant, and, at times, tender. It is
usually fixed but may be slightly movable if it involves a tendon sheath.
Shining a light (pen light) through the mass confirms the fluid-filled cyst and
aids in the correct diagnosis (transillumination). Clinical examination should
also focus on evaluating for any carpal instability. Commonly, tears
of the scapholunate interosseous ligament can lead to a dorsal ganglion cyst.
TREATMENT
Some ganglia disappear
spontaneously. Treatments such as traumatic rupture, aspiration, and injections
are associated with a high recurrence rate. Complete surgical
excision of the ganglion and the ligamentous tissue at its base is the
treatment of choice and usually prevents recurrence. Removal of the stalk and
under- lying swath of capsular tissue is critical to diminish recurrence.
Arthroscopic techniques for removal of ganglia are gaining favor with the goals
of removing the cyst with less tissue trauma and more expedient recovery.
