Ganglion cysts of the hand and wrist

Last revised by Dr Joachim Feger on 11 Dec 2021

Ganglion cysts are the most common mass-like lesions of the hand and wrist.

They are the most common soft-tissue tumors of the hand and occur most frequently in the age group of 20-40 years. Women are more commonly affected 1-3.

Ganglion cysts of the hand and wrists are more likely to develop in gymnasts 1.

A typical presentation of wrist and hand ganglia is a lump of varying size, sometimes growing with activity and shrinking with rest. Due to mass effect, they might cause pain, paresthesia, impaired function or cosmetic problems 1,2.

Ganglion cysts of the wrist and hand typically feature a pedicle that connects them to the joint. Otherwise, they are well-defined, sharply marginated, lobulated, uni- or multilocular. They are surrounded by dense connective tissue, lack a synovial lining and are filled with viscous, mucoid material 1-3.

The fluid within the ganglion cysts is thicker and different from the synovial fluid in the joint. The pathogenesis is controversial and comprises the following theories 3:

  • cyst formation as a consequence of stress, tissue irritation or a degenerative process
  • mucin secretion by mesenchymal cells
  • mucoid degeneration of the extra-articular tissues

Typical locations of wrist ganglia include the following 1,4:

  • volar aspect of the wrist between the radial artery and the flexor carpi radialis
  • dorsum of the wrist with the scapholunate ligament and dorsal capsule as the most frequent sites of origin
  • other volar locations include:
    • scaphotrapezial
    • trapeziometacarpal
    • flexor tendon sheath

There is some discordance to whether most wrist ganglia are found at the volar aspect between the radial artery and the flexor carpi radialis tendon or the dorsum of the wrist 1,4.

Plain radiographs of the hand and wrist show the bony structures and cannot visualize a ganglion cyst as such. They might, however, show important differential diagnoses.

On ultrasound ganglion cysts are typically hypoechoic to anechoic and show well-defined, smooth-walled margins 5. They might show internal septations and display an acoustic enhancement.

MRI is an accurate modality for the visualization and evaluation of ganglion cysts with a reported sensitivity and specificity of 94.7% and 94.4% 1,5. The typical appearance is that of a well-defined, multiloculated cystic lesion with a stalk.

  • T1: usually hypointense but will depend on protein content
  • T2: hyperintense
  • PDFS/T2FS: hyperintense

Spontaneous resolution occurs in up to 50% of cases. Therefore management options depend vastly on clinical symptoms and patient wishes. They do not require treatment as such, only in case of pain, impaired function or cosmetic reasons.

Treatment options include watchful waiting, US-guided aspiration as well as arthroscopic or surgical excision the latter offering improved resolution but being most invasive 1-3.

In 1743 Heister gave a management recommendation, that it could be dispersed by rubbing the ganglion each morning with saliva and binding a piece of lead upon it for several weeks 3.

Conditions that can mimic the presentation and/or the appearance of wrist and hand ganglia include 5:

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Cases and figures

  • Case 1: dorsal
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  • Case 2: dorsal
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  • Case 3: volar
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  • Case 4: volar - ulnar side
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  • Case 5
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  • Case 6: scaphotrapezial joint ganglion cyst
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