Ganglion cyst

Ganglion cysts are non-malignant cystic masses that occur in association with musculoskeletal structures. They are the most common soft tissue mass in the hand and wrist. 

Ganglion cysts are sometimes also simply referred to as ganglia or a ganglion, but should not be confused with the anatomical term ganglion.

They occur more commonly in young women (especially in and around the hand) 7.

They can cause a myriad of symptoms depending on location due to mass effect on adjacent structures, and these are best discussed under location specific subsites. A proportion of patients have a history of trauma.

The etiology of ganglion cysts is unclear and are generally thought to result from myxoid degeneration of the connective tissue associated with joint capsules and tendon sheaths 10. They may represent sequelae of synovial herniations or coalescence of small degenerative cysts arising from the tendon sheath, joint capsule or bursae. Typically, they are attached to the underlying joint capsule or tendon sheath 8.

Some ganglion cysts can occur in post-traumatic and post surgical situations 12.

Histologically, ganglia have a thin connective tissue capsule, but no true synovial lining, and contain mucinous material filled with gelatinous fluid rich in hyaluronic acid and other mucopolysaccharides 4.

They can occur within

They can occur in numerous locations but most commonly (70-80% of cases) occur in relation to the hand or wrist (ganglion cysts of the hand and wrist) in this location, notable specific subsites include 1:

  • dorsum of the wrist: ~60% of all hand ganglion cysts
  • volar aspect of the wrist: ~20%
  • flexor tendon sheath: ~10%
  • in association with the distal interphalangeal joint: ~10%

Other notable locations include:

There are many ways of classifying ganglion cysts.

The vast majority are anechoic to hypoechoic on ultrasound and have well-defined margins 3,5. Many demonstrate internal septations as well as acoustic enhancement 5.

Usually seen as a unilocular or multilocular rounded or lobular fluid signal mass, adjacent to a joint or tendon sheath. Very small cysts may simulate a small effusion, but a clue to the diagnosis is the paucity of fluid in the remainder of the joint and the focal nature of the fluid. Periosteal bone formation may be visible.

Signal characteristics include:

  • T1: typically ganglia are low signal although high proteinaceous content or hemorrhage may result in lesions appearing isointense or hyperintense on T1 weighted images
  • T2/STIR: typically high signal

Ruptured cysts are often irregularly delineated and show pericapsular edema on T2 weighted image 9. The cyst itself may show diffuse enhancement after intravenous administration of gadolinium contrast, but there is often an absence of enhancement of the pericapsular soft tissue edema.

Ganglion cysts are thought to be first described by Hippocrates as ‘‘knots of tissue containing mucoid flesh’’.

General imaging differential considerations include:

  • synovial cyst: these have a synovial lining, and although histologically distinct from ganglia, are indistinguishable on imaging 1

Article information

rID: 18707
Synonyms or Alternate Spellings:
  • Ganglion cysts
  • Ganglion cyst - MSK
  • Ganglion cyst general
  • Ganglion cyst - musculoskeletal

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Cases and figures

  • Case 1: wrist
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  • Case 2: intra articular ganglion cyst of knee
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  • Case 3: in association with vastus lateralis
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  • Case 4: in sinus tarsi
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  • Case 5: in FCR tendon sheath
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  • Case 6: wrist ganglion cyst - pseudo-solid appearance
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  • Case 7: in dorsum of wrist
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  • Dorsal wrist gang...
    Case 8: in dorsum of wrist
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  • Case 9: close to tarsal tunnel
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  • Case 10: cyst recurrence on lateral aspect of knee
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  • Case 11: spinoglenoid notch ganglion cyst
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  • Case 12: peri A1 pulley ganglion
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  • Case 13
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  • Case 14: spinoglenoid notch ganglion cyst
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  • Case 15: spinoglenoid notch ganglion cyst
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  • Case 16: post traumatic
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  • Case 17 : pisotriquetral joint cyst
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  • Case 18: thenar eminence ganglion
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  • Case 19: volar wrist ganglion cyst - ulnar side
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