Epidemiology
Most common tumour of hand
F > M
2nd - 4th decade
Aetiology
Unknown
Trauma
Mucoid degeneration of collagen tissue
Synovial herniation
Location
1. Dorsal
- scapho-lunate ligament
- radial to EDC
2. Dorsal
- TFCC
3. Volar
- scapho-trapezial joint
- between FCR and APL
4. Retinacular
- along flexor sheaths
- A1 / A2 pulley
5. Mucoid cyst
- associated with DIPJ OA and osteophyte
Recurrence rate
Dorsal 5%
Volar 20%
Clinical
Most asymptomatic
- soft to firm
- 1-3 cm
- transilluminate
Mucoid cyst can groove nail bed
- important to remove osteophyte as well to prevent recurrence
McKeon J Hand Surg Am 2013
- association with ligamentous laxity and positive scaphoid shift test
Pathology
Cyst
- cavity lined by epithelium
- viscous mucin
- hyaluronic acid
Management
Non - operative
Aspiration + HCLA injection
- usually needs multiple attempts
Khan J Hand Micosurg 2011
- aspiration plus steroid sucessful in 60%
Operative
Excision of ganglion
- find neck and dissect down to capsule
- remove capsular window
1. Open Dorsal SLL
Technique
- radial side EDC
- protect SRN
- follow down
- excise neck and capsule
Studies
Edwards J Hand Surg Am 2009
- arthroscopic excision in 55 patients
- no recurrence
Kang J Hand Surg Am 2008
- RCT of 72 patients
- open v arthroscopic
- recurrence in 3/28 in arthroscopic
- recurrence in 2/23 in open
2. Open Volar STJ
Technique
- between FCR and radial artery
- protect palmar branch median nerve
Complications
Recurrence
Nerve injury
Stiffness
Tendon damage