The patient is concerned about a rubbery, rounded swelling
emerging from the general area of a tendon sheath of the
wrist or hand. It may have appeared abruptly, been present
for years, or fluctuated, suddenly resolving and gradually
returning in pretty much the same place. There is usually
little tenderness, inflammation, or interference with
function, but ganglion cysts are bothersome when they get in
the way and painful when repeatedly traumatized.
What to do:
Undertake a thorough history and physical exam of the hand
to ascertain that everything else is normal. X rays are of
no value unless there is some question of bony pathology.
Explain to the patient that this is a fluid-filled cyst,
spontaneously arising from bursa or tendon sheath, and
posing no particular danger. Treatment options include:
hitting it with a large book to rupture the cyst, with a
fair chance of recurrence; draining the contents of the cyst
with an 18-gauge needle to reduce its size and then
injecting corticosteroid, also with good chance of
recurrence; arranging for a surgical excisision, which will
provide definitive pathologic diagnosis, but the dissection
is sometimes unexpectedly extensive, and still allows some
chance of recurrence; and doing nothing, in which case the
cyst may spontaneously drain and may recur.
Follow the wishes of the patient regarding above and
arrange for followup.
Discussion
Ganglion cysts are outpouchings of bursae or tendon sheaths,
with no clear etiology and no relation to nerve ganglia.
Perhaps they got their name because their contents are like
"glue." Reassurance about their insignificance is often the
best we can offer patients.
