Ganglion cysts are the most common benign lesion of the hand/wrist.
Typically, insidious onset with no predisposing conditions.
Usually only a cosmetic problem but local pain and neurovascular compression may occur.
Conservative management usually suffices if no neurovascular compromise.
Aspiration of dorsal cysts can be therapeutic and diagnostic.
Surgical excision has a higher rate of resolution but recurrence is possible.
No reported malignant transformation.
Ganglion cysts are smooth, soft, benign masses that are usually located on the wrist (dorsal or volar aspect) with one or more communicating stalks into the wrist joint or surrounding structures. They can be single or multiloculated and are filled with viscous, sticky, mucinous fluid.
History and exam
Key diagnostic factors
- subcutaneous wrist mass
- wrist pain
- nontender mass
- increased mass size after activity
- transilluminating mass
Other diagnostic factors
- unable to recall onset of lump
- cosmetically unpleasing lump
- hand or finger coolness
- paresthesia or weakness of fingers
- reduced sensation in the hand
- female sex
- age 10 to 30 years
- scapholunate instability
1st investigations to order
- no initial test
Investigations to consider
- cyst aspiration
- erythrocyte sedimentation rate
- C-reactive protein
- complete blood count
- uric acid
- wrist x-ray
- magnetic resonance imaging
without neurovascular compromise
with neurovascular compromise
Philip Blazar, MD
Associate Professor of Orthopedic Surgery
Harvard Medical School
Brigham and Women's Hospital
PB declares that he has no competing interests.
Dr Philip Blazar would like to gratefully acknowledge Dr Marco Rizzo and Dr Kristofer S. Matullo, previous contributors to this topic.
MR and KSM declare that they have no competing interests.
George Chloros, MD
Department of Orthopedic Surgery
Wake Forest University Baptist Medical Center
GC declares that he has no competing interests.
Lorenz Buchler, MD
Clinic for Orthopedic Surgery
University Hospital Bern
LB declares that he has no competing interests.
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