Makindo Medical Notes

🖐️ Ganglion cysts are benign, non-cancerous swellings arising near tendons or joints, most often on the wrist or hand. They contain a jelly-like synovial fluid. They are the most common soft-tissue lesion of the hand and can fluctuate in size.

🔎 Etiology

The exact cause is unclear, but they likely arise from degeneration or herniation of synovial tissue. Risk factors:

• 🔁 Repetitive use / trauma: Overuse or repeated micro-injury.
• ⚡ Joint or tendon irritation: Chronic stress on capsule or tendon sheath.
• 🫧 Synovial herniation: Fluid outpouching through joint capsule.

🩺 Clinical Presentation

• Appearance: Smooth, rounded, firm or rubbery lump under skin; often translucent. Size: pea → golf ball.
• Location: Common on dorsal wrist; also volar wrist (⚠️ close to radial artery), fingers, palm, or foot.
• Symptoms: Frequently painless, but may cause discomfort, aching, or weakness if compressing nerves. Worse with activity.
• Exam tip 💡: They move with the tendon sheath or joint capsule, not freely mobile like lipomas.

📍 Types of Ganglion Cysts

• Dorsal Wrist Ganglion: Back of wrist; most common.
• Volar Wrist Ganglion: Palm side; may involve radial artery (care in aspiration!).
• Flexor Sheath Ganglion: Base of finger; causes pain with grip.
• Mucous Cyst: Over DIP joint; often with OA & nail ridging.

🧾 Diagnosis

Usually clinical. Supportive tests include:

• 💡 Transillumination: Fluid-filled cyst glows.
• 🩻 Ultrasound: Confirms cystic nature, relation to tendon/joint.
• 🧲 MRI/X-ray: Exclude intra-articular pathology, OA, or pre-op planning.

🔀 Differential Diagnosis

• Lipoma
• Epidermoid cyst
• Gouty tophus
• Rheumatoid nodule
• Synovial sarcoma (rare)

💊 Management

• Conservative:
  • 👀 Observation: Many resolve spontaneously.
  • 🩹 Immobilisation: Splinting reduces fluid pressure.
  • 💉 Aspiration: Simple, but recurrence up to 70%.
  • 🌡️ Steroid injection: May reduce recurrence post-aspiration.
• Surgical:
  • 🔪 Excision (ganglionectomy): Removes cyst + stalk; recurrence ~10–20%.
  • 🔍 Arthroscopic removal: Minimally invasive option, esp. wrist.

⚠️ Complications

• ♻️ Recurrence: Common after aspiration; less with excision.
• 🧠 Nerve compression: Median or radial nerve irritation ➝ paraesthesia, weakness.
• 🦠 Infection: Rare post-aspiration or surgery.
• 💥 Historical note: "Bible therapy" (smashing cyst with a book) — no longer recommended!

📚 Patient Education

• 🧘 Activity modification: Avoid repetitive wrist stress.
• 📉 Prognosis: Benign, but recurrence common.
• ⚕️ When to seek review: Rapid growth, persistent pain, neuro symptoms, or recurrent cysts.

📅 Follow-up

Monitor asymptomatic cysts. Refer for surgery if recurrent, painful, or functionally limiting. Post-op follow-up to detect recurrence or infection.

✅ Summary

Ganglion cysts are common, benign swellings arising from joints/tendons. Most are harmless, with treatment ranging from observation → aspiration → excision. Surgery has lower recurrence, but conservative care is often sufficient. Prognosis is excellent. 🌟