Ganglion Cyst

A 72-year-old woman presented for evaluation of a large swelling onher dorsal wrist, which had been present for 2 years. The protuberancewas not painful or tender; the patient was otherwise in goodhealth.Joe Monroe, PA-C, of Tulsa, Okla, writes that ganglion cystsresult from myxomatous degeneration--possibly caused by antecedent trauma--that occurs in a portion of the connective tissue of the joint capsule. Althoughganglia feel firm, they are filled with a clear, extremely viscous gelatinousfluid. The cysts may become large enough to cause discomfort or evennerve compression.Ganglia frequently develop above the scapholunate articulation, as in thispatient; however, they also can occur on the dorsa of the feet and on the radialaspect of the wrist. Although the differential includes neoplasia, ganglion cystsare so common and characteristic in these locations that the diagnosis is usuallyobvious. An otoscope can be used to confirm translucence and rule out solidtumors.Ganglion cysts are often untreated. For patients who are in pain or unhappywith the cyst's appearance, treatment options include evacuation through alarge-gauge needle, intralesional injection with triamcinolone (10 to 20mg/mL), and surgical removal. Evacuation can reduce the size and prominenceof the cyst, lessen symptoms, and confirm the diagnosis by the appearanceand thickness of the fluid. This patient chose to live with her cyst, since itwas stable and asymptomatic.