Ganglion cysts are the most common soft tissue “tumor” of hand. They represent approximately 50-70% of all hand masses. The majority of these are located on the dorsum, or top of the hand. They are 4 times more likely to occur in women than men. These are most common in individuals in the 2nd-4th decades of life. In pre-adolescents, spontaneous resolution can occur, but it is uncommon in adolescents and adults. A ganglion is a technically a cyst-like mass associated with joint capsule or tendon sheath- filled with mucoid fluid. The fluid is thick and jelly-like. The reasons that individuals develop ganglion cysts remain unclear. They are usually quite noticeable, and can be uncomfortable, especially with wrist extension and weight bearing (such as when pushing off). These cysts are not cancerous, nor can they spread to other areas.
The diagnosis is usually based on the location of the lump and its appearance. They are usually oval or round and range from soft to firm. Light will often pass through these lumps (transillumination) and this can assist in the diagnosis. The do not appear on xrays, but can be seen on MRI scans.
Treatment can be categorized as Non-Surgical, and Surgical.
Non-surgical treatment has included digital pressure, injections and/or aspiration of the cyst contents. However, success rates with these techniques are low, and recurrence rates can be as high as 90%.
Surgery involves removing the cyst, as well as the stalk of the cyst which frequently originates deep within the wrist joint. In addition, frequently a portion of the surrounding joint capsule is removed. In the case of dorsal wrist ganglion cysts, both traditional open and arthroscopic techniques may be utilized.
Goals of Treatment are to produce a cosmetically acceptable scar while maintaining wrist motion. The surgery should also provide a low rate of recurrence. As ganglion cysts frequently originate deep within the wrist joint, arthroscopy represents a minimally invasive technique for removal of these cysts. The arthroscopic approach provides excellent visualization of the wrist joint, and allows targeted removal of the ganglion stalk. Removal of the stalk or origin of the ganglion is the likely reason that arthroscopic ganglion removal yields a low rate of recurrence. An added benefit is the improved cosmetic appearance after a minimally invasive arthroscopic procedure as compared to an open procedure. The smaller incisions produce less scarring with the arthroscopic procedure as compared to an open surgical excision. This allows rapid return of motion and prompt resumption of activities.
