9.25 Ganglion Cysts
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agk's Library of Common Simple Emergencies

Presentation
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The patient is concerned about a rubbery, 
rounded swelling emerging from the general area 
of a tendon sheath of the wrist or hand. It may 
have appeared abruptly, been present for years, 
or fluctuated, suddenly resolving and gradually 
returning in pretty much the same place. There 
is usually little tenderness, inflammation, or 
interference with function, but ganglion cysts 
are bothersome when they get in the way and 
painful when repeatedly traumatized.

What to do:
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- Undertake a thorough history and physical 
    exam of the hand to ascertain that every- 
    thing else is normal. X rays are of no 
    value unless there is some question of bony 
    pathology.
- Explain to the patient that this is a 
    fluid-filled cyst, spontaneously arising 
    from bursa or tendon sheath, and posing no 
    particular danger. Treatment options 
    include: hitting it with a large book to 
    rupture the cyst, with a fair chance of 
    recurrence; draining the contents of the 
    cyst with an 18-gauge needle to reduce its 
    size and then injecting corticosteroid, 
    also with good chance of recurrence; 
    arranging for a surgical excisision, which 
    will provide definitive pathologic 
    diagnosis, but the dissection is sometimes 
    unexpectedly extensive, and still allows 
    some chance of recurrence; and doing 
    nothing, in which case the cyst may 
    spontaneously drain and may recur.
- Follow the wishes of the patient regarding 
    above and arrange for followup.

Discussion
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Ganglion cysts are outpouchings of bursae or 
tendon sheaths, with no clear etiology and no 
relation to nerve ganglia. Perhaps they got 
their name because their contents are like 
"glue." Reassurance about their insignificance 
is often the best we can offer patients.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
 Longwood Information LLC 4822 Quebec St NW Wash DC
 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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