Patient will present as→ a 54-year-old male presents with a slowly enlarging mass on the dorsum of his left wrist which has been present for 3 years. He denies any significant symptoms. Physical exam shows a 1 cm palpable mass that transilluminates.
A ganglion is a noncancerous mucin-filled synovial cyst caused by either trauma, mucoid degeneration or synovial herniation
- Occurring usually on the hands, especially on the dorsal aspect of the wrists
- Median or ulnar nerve compression and hand ischemia due to vascular occlusion may be caused by volar ganglion
- Usually asymptomatic but may cause issues with cosmesis
Diagnosis is usually clinical
- Firm and well-circumscribed often fixed to deep tissue but not to the overlying skin, transilluminates
- Vascular exam: Allen's test to ensure radial and ulnar artery flow for volar wrist ganglions
- Ultrasound: useful for differentiating a cyst from a vascular aneurysm, may provide image localization for aspiration while avoiding artery.
Most ganglia do not require treatment. However, if the patient is disturbed by its appearance or if the ganglion is painful or tender, a single aspiration with a large-bore needle is effective in about 50% of patients.
- Observation is the first line of treatment in adults. In children 76% resolve within 1 year.
- Aspiration is the second line of treatment in adults with dorsal ganglions - aspiration typically avoided on the volar aspect of wrist due to the radial artery.
- Excision if severe symptoms or neurovascular manifestations. Recurrence rates after surgical excision are about 5 to 15%.
Question 1 |
Referral to an orthopedic oncologist Hint: Referral to an orthopaedic oncologist is not indicated. | |
Surgical excision with wide margins | |
Observation | |
Autologous bone marrow aspirate injection Hint: Autologus bone marrow aspirate injection is a treatment option for unicameral bone cysts and N-Butyl-Cyanoacrylate injections have been described for treatment of hemangiomas | |
Injection of N-Butyl-Cyanoacrylate Hint: Autologus bone marrow aspirate injection is a treatment option for unicameral bone cysts and N-Butyl-Cyanoacrylate injections have been described for treatment of hemangiomas |
List |