Ganglia are cystic swellings occurring usually on the hands, especially on the dorsal aspect of the wrists. Aspiration or excision is indicated for symptomatic ganglia.
(See also Overview and Evaluation of Hand Disorders.)
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Ganglion cysts are the most common cause of soft-tissue swellings affecting the hand and wrist. They usually develop spontaneously in adults aged 20 to 50, with a female:male preponderance of 3:1 (1). The size of a ganglion may vary over time and with use of the hand.
Reference
1. Kuliński S, Gutkowska O, Mizia S, Gosk J: Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases. Adv Clin Exp Med. 2017;26(1):95-100. doi:10.17219/acem/65070
Etiology of Ganglia
The cause of most ganglia is unknown. The cystic structures are near or attached (often by a pedicle) to tendon sheaths and joint capsules. The wall of the ganglion is smooth, fibrous, and of variable thickness. The cyst is filled with clear gelatinous, sticky, or mucoid fluid of high viscosity. The fluid in the cyst is sometimes almost pure hyaluronic acid.
Most ganglia are isolated abnormalities. The dorsal wrist ganglion arises from the scapholunate joint and constitutes about 65% of ganglia of the wrist and hand. The volar wrist ganglion arises over the distal aspect of the radius and constitutes about 3 to 20% of ganglia. Flexor tendon sheath ganglia and mucous cysts (arising from the dorsal distal interphalangeal joint) make up the remaining 7 to 12%. Ganglia may spontaneously regress.
Diagnosis of Ganglia
Examination
Ganglia are evident on examination. Because they are cystic, they transilluminate. Another type of mass (that is solid) on the dorsal wrist occurs in patients with inflammatory tenosynovitis or rheumatoid arthritis; it is easily differentiated by its irregular appearance, its lack of transillumination, and its association with proliferative extensor tenosynovitis (ie, it moves with tendon excursion during flexion and extension of the fingers).
Treatment of Ganglia
Aspiration or excision if troublesome
Most ganglia do not require treatment. However, if the patient is disturbed by its appearance or if the ganglion is painful or tender, a single aspiration with a large-bore needle is effective in about 50% of patients. Attempting to rupture the ganglion by hitting it with a hard object risks local injury without likely benefit.
Nonsurgical treatment fails in over 50 % of patients, necessitating surgical excision (1). Excision can be done via arthroscopic or standard open surgery. Recurrence rates after surgical excision are about 5 to 15% (2).
Treatment references
1. Dias JJ, Dhukaram V, Kumar P: The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. 2007;32(5):502-508. doi:10.1016/J.JHSE.2007.05.007
2. Thornburg LE: Ganglions of the hand and wrist. J Am Acad Orthop Surg. 1999;7(4):231-238. doi:10.5435/00124635-199907000-00003
