Ganglion

Definition/diagnostic criteria Ganglions are benign cystic soft-tissue swellings that typically occur near joints or tendons. They are most commonly found around the wrist or hand but can also appear on ankles, feet or knees. These cysts are filled with a jelly-like fluid and can vary in size, often fluctuating over time. Diagnosis is usually clinical, based on the appearance and location of the cyst. They may or may not be painful and can change in size or disappear spontaneously.

Epidemiology Ganglion cysts are the most common type of soft-tissue tumour of the hand and wrist. They occur more frequently in women and the majority of cases are seen between the ages of 20-40. However, they can occur at any age including in children.

Diagnosis
Clinical features: Ganglions present as visible or palpable lumps. They are typically round or oval and can feel spongy or firm. Pain or discomfort may be present, particularly with joint movement or pressure on the cyst. Wrist ganglions may be visible when the wrist is flexed. While they can vary in size, most are between 1.5-2.5 cm in diameter. Dorsal wrist ganglions are the most common, but they can occur on the palmar side of the wrist, at the base of fingers or around other joints.

Investigations: Typically, the diagnosis is clinical and no investigations are necessary.

• If the diagnosis is uncertain or if there is suspicion of another underlying condition, ultrasound or MRI might be used. These investigations can confirm the cystic nature of the swelling and its relationship to nearby structures.
• Ultrasound is particularly useful for distinguishing ganglions from solid tumours or other types of cysts.

Treatment Treatment options vary depending on the symptoms and the patient’s preferences. Observation is often acceptable as many cysts are asymptomatic and can resolve spontaneously.

• For symptomatic ganglions, options include aspiration, which involves drawing out the fluid with a needle, and surgical removal.
• Aspiration may provide temporary relief but has a higher recurrence rate compared with surgery.
• Surgical excision is usually reserved for persistent or recurrent cysts, or when the ganglion causes significant pain or functional impairment. It has a lower recurrence rate but comes with the usual risks of surgery.

Prognosis The prognosis for ganglion cysts is generally good, particularly for those that are asymptomatic or mildly symptomatic. Many cysts resolve spontaneously over time. When intervention is needed, both aspiration and surgical excision generally have good outcomes, although recurrence can occur, particularly with aspiration. Long-term complications are rare but can include nerve damage or joint stiffness, particularly if the cyst is adjacent to these structures.