Ganglion

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