1. GANGLION CYSTS

2. What is a ganglion cyst?
A ganglion cyst is the most common soft tissue mass in the hand and wrist.
These cysts are sacs that arise from a joint or tendon sheath and become filled with a gelatinous fluid.
It is believed the cysts are a result of a weak spot or degeneration of tissue lining a joint or tendon sheath.

3. Common types of ganglions
DORSAL CARPAL GANGLION CYST
Most common location of a ganglion cyst.
Often arises from a weak spot in the scapholunate ligament on the back of the hand.

4. VOLAR GANGLION CYST
2nd most common location of a ganglion cyst of the wrist.
Often arises from a weak spot in either the radiocarpal joint or STT joint

5. RETINACULAR CYST
This variant of a ganglion cyst occurs on the palm side of the hand at the joint where the fingers join the palm.
These cysts arise off the A1 or A2 pulley of the flexor tendon sheath.

6. MUCOUS CYST
These are ganglions that occur on the back of the finger at the DIP (distal interphalangeal) joint, the joint closest to the fingernail.
Most often are associated with underlying osteaoarthritis at this joint.

7. Treatment options Splints Anti-inflammatory medications
May be used to provide pain relief by resting the offending joint or tendon sheath
Anti-inflammatory medications
Can be taken orally to reduce swelling and relieve pain
Try to modify or avoid activity that causes pain

8. Aspiration of the cyst
In the office, it can be attempted to puncture the cyst with a needle and aspirate the fluid from it.
This may eliminate the cyst completely, but there is a high rate of recurrence following this procedure.

9. Surgical options
Ganglion cysts are often removed for a variety of reasons, inluding:
Pain relief
If causing limitations to range of motion
Aesthetically unpleasing
Specifically in the case of mucous cysts, it is important to surgically remove them if they rupture. This is to prevent infection of the underlying joint.
Sometimes an MRI is ordered to confirm origin of the stalk of the cyst so we can ensure this area is addressed intraoperatively.

10. Surgical treatment
Surgical treatment for this involves removing the cyst sac and addressing the underlying cause, such as ablating the weak spot in the ligament or removing the bone spurs from an arthritic joint.
This is an outpatient procedure and takes about minutes to perform.

11. Surgery details Dorsal carpal ganglion cysts:
This procedure is performed under regional anesthetic, which involves a nerve block at the shoulder.
Near the location of these cysts there is a nerve called the PIN (posterior interosseous nerve). Its function is to provide pain fibers to the wrist capsule and can be a contributing factor to pain in this location. It is also removed during the procedure.
Volar carpal ganglion cysts:

12. Surgery details Retinacular cysts: Mucous cysts:
This procedure is performed under local anesthetic, involving an injection near the site of the cyst.
Mucous cysts:
This procedure is performed under local anesthetic, involving an injection that will the numb the finger.
These cysts can thin the skin and sometimes require transfer of nearby skin to cover the defect.
In all situations, we are able to give you some sedative medication through an IV to keep you comfortable.

13. Risks
Anesthetic
Infection
Numbness
Recurrence

14. Post-operative care
A soft dressing is applied after surgery. You will be able to use your hands for light activity later that day.
Keep the surgical dressing and incision clean and dry. After 48 hours you may remove the soft dressing and your incision may get wet in the shower, but no soaking. Apply a band-aid to keep the incision clean if necessary.
Approximately days post- operatively you will return to Dr. Foad’s office for a follow-up visit and suture removal.