Ganglion
Ganglion
- Cystic swelling related to a synovial lined cavity
- joint
- Tendon sheath
- Origin - controversial
- Seen as pocket of synovium communicating with joint / tendon sheath
- Or as muxomatous degeneration of fibrous tissue
- Occur anywhere in the body
- Commonly found around wrist, dorsum of hand, dorsum of ankle
- Most common tissue mass found in the hand
Differential diagnoses
- Bursae
- Cystic protrusions from synovial cavity of arthritic joints
- Benign giant cell tumours of flexor sheaths
- Malignant swellings - synovial sarcoma
Treatment options
- Non surgical
- Watch and wait
- Aspiration followed by 3 weeks of immobilisation (successful in 30-50% of patients)
- Surgical
- Excision to include the neck of the ganglion at its site of origin
Complications of surgical treatment:
- Wound complications; scar, haematoma, infection
- Recurrence: ~5-20%
- Neurovascular injury
Approach
- Expose to elbows
- Ask patient to place hands and plam upwards and on a pillow
Inspect
- Single
- Hemispherical swelling
- Look for scars (recurrent, excisions)
Palpate
- Smooth surface
- Can be multiloculated
- If large - soft and fluctuant / if small - firm and tense
- Associated with synovial lined structure such as tendon or joint
- Weakly transilluminatable due to viscous fluid contents
Finish
- ?How ganglion affects life
- Similar lumps elsewhere
- Which hand dominant (affects treatment options)
- Occupation (affects treatment options)
