Diseases

Ganglion Cysts

A Ganglion is a cystic swelling occurring in relation to tendon sheath synovial sheath or joint capsule. It contains clear gel-like fluid. it is also called synovial cysts. 95% of hand tumours are to be found benign in course of excluding cutaneous malignancy. Among them, 60% is the ganglion cysts. The problems that ganglion cysts present can be varied due to the location.

O/E: it is firm nodule fixed to the tendon sheath or joint capsule. It may fluctuate. The nodule may be unilocular or multilocular. Cysts contain clear, colourless and gelatinous fluid.

Common site

  • Dorsum of wrist near scaphoid-lunate articulates)
  • flexor aspect of the wrist
  • Around ankle joint-occasionally

Pathogenesis

  • Cystic degeneration of tendon sheath.
  • Leakage of synovial fluid through the joint capsule
  • There are small islets o micro spaces in the synovial sheath which often fuse together to one of them gets enlace o form ganglion.

Clinical features

  • Well localized swelling which is smooth, soft, cystic, or tensely cystic (Paget’s test is positive), non-tender transilluminant. It is mobile but Mobily restricted when the tendon is contracted against resistance.
  • Occasionally it is communicating with the joint capsule
  • Often pain, tenderness and restricted joint movement may be the presentation (but rare)

Differential diagnosis

  • Lipoma
  • Lymph cyst
  • Sebaceous cyst
  • The Small ganglion is often mistaken for sesamoid bone or exostoses.
  • Bursa

Treatment

  • The asymptomatic ganglion is better left alone because of the high recurrence rate.
  • Excision: usually done under local anaesthesia (lignocaine plain 2%). Patients should be explained by the high recurrence rate (30%). After excision always its should be sent for histopathology. The application of the firm crepe bandage for 4 weeks is better in these patients.
  • Aspiration and sclerosant injection are useful.

(In olden days people who have ganglion used to rupture it by  using bible book).

Prevention

The exact cause of ganglion cysts is unknown so it is very difficult to say how to prevent them. Early evaluation and treatment are recommended.  

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