2. LEARNING OBJECTIVE
By the end of seminar, student should be able to
• Explain what is ganglion cyst
• Know the finding in ganglion cyst and what
investigation to be done
• Describe the management for ganglion cyst
3. INTRODUCTION
• Ganglion
– Small cystic swelling filled by mucin
• Also known as Bible cyst
• Common in women, and 70% occur in people
between the ages of 20-40.
• Rarely, ganglion cysts can occur in children
younger than 10 years.
4. Cont.
• Commonly occur on the back of the hand at the wrist joint but
they can also develop on the palm side of the wrist.
• On the back of the wrist, they become more prominent when
the wrist is flexed forward.
• Other site (less common)
– The base of the fingers on the palm (small pea-sized
bumps)
– The fingertip, just below the cuticle, where they are called
mucous cysts
– The outside of the knee and ankle
– The top of the foot
5.
6. ETIOPATHOLOGY
• NOT A TRUE CYST!
• Theory of formation
1. Synovial herniation
2. Mucus cyst formation
3. Degeneration of connective tissue and cyst
formation
7. CLINICAL FEATURE
• Common in female
• Size show variation with time
• Intermittenly painful, usually following acute or repetitive
trauma,
• Up to 35% are without symptoms except for appearance.
• Pain
– Chronic
– Made worse by joint motion.
• When the cyst is connected to a tendon, weakness in the
affected finger.
8. Cont.
INSPECTION
• Swelling on dorsum of wrist (sometimes on
volar aspect)
• Pea size (occassionally larger)
PALPATION
• Very firm/bony hard
• Wrist ROM normal
9. A traumatic ganglion cyst.
This person came to the
emergency department with a
painful bump after the wrist
was hit by a car door.
The jellylike fluid taken from
the cyst in Image 1.
Its presence confirms the
diagnosis of a ganglion cyst.
10. A ganglion cyst that has been
operated on in the past. This
ganglion returned because
this person plays the cymbals
in her school band
An ultrasound image shows
the ganglion cyst
(area between markers)
from Image 1.
1
11. INVESTIGATION
• Ultrasonography
– Confirmation by using ultrasound.
– Determine whether the bump is fluid-filled (cystic) or if it is
solid.
– Detect whether there is an artery or blood vessel causing
the lump.
• MRI
– To see the wrist
– Drawback is the cost of the procedure
• Refer to a hand surgeon
– Large or solid
– Involves a blood vessel (artery).
13. BULLET POINT !!
• Commonest cystic swelling on the dorsum of the
wrist.
• Mucoid degeneration of the tendon sheath or the
joint capsule.
• No symptoms other than the swelling
• Mild discomfort or pain.
• Aspiration of the cyst and an injection of hylase
given.
• Recurrance, excision .
