Describes benign swellings on upper limb especially on wrist

1. GANGLION CYST

2. ROAD MAP
 INTRODUCTION /DEFINITION
 EPIDEMIOLOGY
 RISK FACTORS
 PATHOPHYSIOLOGY
 SIGNS AND SYMPTOMS
 DIFFERENTIAL DIAGNOSIS
 DIAGNOSIS
 MANAGEMENT
 COMPLICATIONS
 CONCLUSION

3. INTRODUCTION
 A Ganglion cyst is a small sac of fluid that forms over a joint or tendon.
Inside the cyst is a thick, sticky, clear, colorless, jellylike material.
Depending on the size, cyst may feel firm or spongy.
 They most commonly show up on the back of the hand at the wrist joint
but they can also develop on the palm side of the wrist, the knee and
ankle.

4. EPIDEMIOLOGY
 Ganglion cysts are the most common soft-tissue tumors of the hand and
wrist. Although anyone can be affected by ganglion cyst they occur three
times as often in women as they do in men.
 They are most commonly seen in older patients ages 20-40 and above.
 They are comparatively rare in children.
 They tend to occur more frequently in people who repeatedly stress their
wrists, such as gymnasts.

5. RISK FACTORS
 Injury to the wrist or finger
 Inflammation in a joint or tendon
 Repetitive wrist or finger activities
 Chronic conditions like arthritis
 Sex (females)
 Age (20-40 years)

6. Pathophysiology of ganglion cyst
 Ganglion cysts are benign soft tissue tumors most commonly encountered
in the wrist on the dorsal aspect and communicate with the underlying
joint via a pedicle.
 Analysis of cystic fluid reveals that it is a gelatinous material containing
mainly hyaluronic acid and lesser amounts of glucosamine, globulins and
albumen. This fluid is different biochemically and is much thicker than
intra-articular synovial fluid. The origin of the fluid has not been fully
elucidated, but it has been postulated to arise from one of three
mechanism.
 First it may originate from within the joint, pumped into the cyst by
motion of the wrist

7. Continuation..
 Secondly from an extra-articular degenerative process resulting in cyst
formation and subsequent communication to the joint.
 Finally it may originate from mesenchymal cells within the cell wall.
 It is possible that a combination of these mechanisms contribute to the
ganglion cyst.

8. Signs and symptoms
 Swelling that may appear over time or suddenly
 A soft bump or mass that changes size but doesn’t move.
 Weakness when it is connected to a tendon
 Pain if the cyst presses on a nerve
 Numbness if it presses on a nerve
 Limited range of motion

9. Differential diagnosis
 Tenosynovitis
 Lipoma
 Osteoarthritis
 Sarcoma
 Giant cell tumor of tendon sheath

10. diagnosis
 Investigations;
 Most ganglion cysts are diagonised clinically
 A plain xray film may assist ruling out osteoarthritis or bone malignancies
 Ultra sound and MRI is done inorder to asses the shape, size and depth of
the cyst.
 Aspiration for microscopy
 CT scan to rule out malignancies

11. Management
 If the cyst does not cause any pain, the usual recommended treatment is
to simply monitor, as cysts often disappear spontaneously without
further intervention
 If the cyst causes pain or severely limits range of motion, there are two
main interventions that can be performed.
 1. Aspiration: with this procedure, a needle is placed into the cyst to draw
the liquid material out. The steriod compound(anti-inflammatory) is
injected into the area and the area is put in a splint to keep it from
moving. Aspiration doesnot remove the area that attaches the cyst to the
joint, so they often return.

12. Continuation….
 Surger y:With this procedure ,the cyst and area around it that attaches it
to the joint is excised.

13. complicatins