9.25 Ganglion Cysts

agk’s Library of Common Simple Emergencies

Presentation

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.

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