Ganglion

A ganglion is a synovial sac filled with a gelatinous mass near a joint or tendon, usually visible as a subcutaneous resistance of various sizes, superficially or in depth, most often on the hand, usually preceded by trauma.

Clinical picture

 * a rigid mobile mass in the subcutaneous tissue (usually when connected to the joint with a long stalk), soreness
 * ganglia dorsally on the wrist most common – originating in the joint capsule of the scapholunate region; usually just a cosmetic issue
 * ganglia palmar on the wrist – usually on the radial side originating in the scapholunate or scaphotrapezial joint
 * flexor tendon sheath ganglia - small and stiff resistances, can cause pain when grasping
 * digital mucinous pseudocyst – a cystic formation containing mucous fluid on the dorsal side of the fingers, originating in the arthrotic DIP joint
 * intraosseous ganglia – rare

Diagnostics

 * usually no special tests
 * X - ray in the dorsal digital ganglia to show arthritic changes in the joint or to rule out other causes of pain
 * USG / MRI in occult ganglia
 * ganglion aspiration - fluid is viscous and clear

Therapy

 * wait (most ganglia will spontaneously subside)
 * ganglion aspiration provides relief, but recurrence is common
 * for recurrent symptomatic ganglion of the wrist, excision together with the pedicle as close as possible to the joint from which it originates is indicated (usual post-operative care: extraction of sutures per week, greasing of the scar, exercise the relevant joints according to location)

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