Hand Section of drdcunningham.com
|A ganglion is the most common mass that develops in the hand. Ganglion cysts are benign lesions. No cases of associated malignancy have been reported. A ganglion can be described simply as a fluid-filled sac arising from an adjacent joint capsule or tendon sheath. A ganglion can form from almost any joint or tendon sheath in the wrist and hand.||
|The exact cause of ganglions remains uncertain. The most popular
theory is that ganglions form after trauma or degeneration of the tissue
layer responsible for producing the synovial fluid which normally
lubricates the joint or tendon sheath. The cyst arises from accumulation
of this fluid outside the joint or tendon sheath in a sac or cyst.
Signs and Symptoms
|Ganglions may limit motion in the adjacent joints, or produce
discomfort from compression or distention of local soft tissues.
Particularly large ganglions can be cosmetically unpleasant. Ganglion
cysts of the distal interphalangeal (DIP) joint may produce deformities
of the fingernail. Ganglion cysts arising from the flexor tendon sheath
at the base of the finger may produce pain when grasping. On rare
occasions, ganglion cysts (particularly those associated with the wrist)
may cause changes in the bone.
Ganglion cysts can frequently be diagnosed simply by their location and shape. They are usually not adherent to the overlying skin and are firmly attached to the underlying joint or tendon sheath. Large ganglions may permit the passage of light through their substance (trans-illumination). X-rays are sometimes helpful in diagnosing ganglion cysts, particularly about the distal interphalangeal joint where associated degenerative arthritis is often found. The presence of a grooved nail bed is a classic finding with a mucous cyst. As other lesions can produce swelling in the same sites as ganglions, a 100% accurate diagnosis cannot be provided without aspiration or excision of the mass.
|Ganglion cysts often change in size and may even disappear
spontaneously. For this reason, if the ganglion is asymptomatic, it may
be best to simply observe the mass for a period of time. Ganglions about
the wrist may respond well to a temporary period of immobilization if
The most reliable method of treating a ganglion cyst
is by surgical excision. This is done on an outpatient basis. Ganglions
in the finger can be removed under a local anesthetic. However, those
cysts involving the wrist usually require a regional or general
anesthetic. The ganglion is removed through an incision directly over
the area of swelling. Care is taken to attempt to identify its site of
origin, and to excise a small portion of the joint capsule or tendon
sheath from which it has arisen. In the treatment of a mucous cyst at
the distal interphalangeal joint, it is important to remove any
osteophytes (bony spurs) that may be associated with the origin of this
type of ganglion.
Dr. David Cunningham 3535Blvd. St Charles, Kirkland,Qc. H9H 5B9 514 694-1425