A ganglion cyst is a fluid-filled bump associated with a joint or tendon sheath. It most often occurs at the back of the wrist, followed by the front of the wrist. Onset is often over several months, typically with no further symptoms. Occasionally, pain or numbness may occur. Complications may include carpal tunnel syndrome.The cause is unknown. The underlying mechanism is believed to involve an outpouching of the synovial membrane. Risk factors include gymnastics activity. Diagnosis is typically based on examination with light shining through the lesion being supportive. Medical imaging may be done to rule out other potential causes.Treatment options include watchful waiting, splinting the affected joint, needle aspiration, or surgery. About half the time, they resolve on their own. About three per 10,000 people newly develop ganglion of the wrist or hand a year. They most commonly occur in young and middle-aged females. Presentation
The average size of these cysts is 2.0 cm, but excised cysts of more than 5 cm have been reported. The size of the cyst may vary over time and may increase after activity. Between 50 and 70% of all masses on the hand and wrist are expected to be ganglion cysts. Sites
Ganglion cysts most frequently occur around the dorsum of the wrist and on the fingers. A common site of the occurrence is along the extensor carpi radialis brevis, as it passes over the dorsum of the wrist joint.
Rare cases of intramuscular ganglion cysts in the gastrocnemius muscle of the calf have been reported. It is possible for a cyst to be considerably displaced from the joint. In one extreme case, a ganglion cyst was observed to propagate extensively via the conduit of the common peroneal nerve sheath to a location in the thigh; in such cases surgery to the proximal joint to remove the articular connection may remove the need for a riskier, more extensive surgery in the neural tissue of the thigh. The cysts may intrude into the spine, which may cause pain and dysesthesia in distant extremities.Cystic adventitial disease, in which a cyst occurs within the popliteal artery near the knee, has been proposed recently to occur by an articular mechanism, with a conduit leading from the joint, similar to the development of ganglion cysts, that spreads within the peroneal nerve.Cysts that were compressing one or more nerves and causing bone erosions have been reported to occur near the shoulder joint. Causes
The most commonly accepted probable cause of ganglion cysts is the "herniation hypothesis", by which they are thought to occur as "an out-pouching or distention of a weakened portion of a joint capsule or tendon sheath." This description is based on the observations that the cysts occur close to tendons and joints. The microscopic anatomy of the cyst resembles that of tenosynovial tissue. The fluid is similar in composition to synovial fluid. Dye injected into the joint capsule frequently ends up in the cyst, which may become enlarged after activity.