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ganglion cyst; bible cyst
Etiology:
- trauma or repetitive use
- flaw in joint capsule or joint sheath
- idiopathic
Epidemiology:
- more common in women
- 70% occur in people between 20-40 years of age
Pathology:
- contains clear fluid similar to, but thicker than, normal synovial fluid
- a type of check valve forms that allows fluid out of the joint (into the cyst), but not back into the joint
- origin of cyst is not inflammatory [3]
Clinical manifestations:
- often appears on or around joints & tendons in the hand or foot
- most frequently located around the dorsum of the wrist & on fingers, especially at the scaphoid-lunate joint, which accounts for 80% of all ganglion cysts
- described as dorsal radiocarpal joint mass
Management:
- 40-60% will spontaneously resolve [2]
- observation for patients without pain or symptoms
- aspiration (1-3 procedures): 70-80% cure rate [2]
- surgical resection
- indications:
- recurrences
- cyst interfering with daily activities
- intolerable pain
- weakness
- nerve compression
- recurrence rate
- 5-10% with removal of check valve at the joint capsule
- < 5% if entire cyst complex is completely excised [3]
- glucocorticoid not effective [3]
- immobilization is not effective in preventing accumulation of cyst fluid & prolongs joint stiffness & limits range of motion
- closed rupture no better than observation alone & is not recommended [3]
General
cyst
References
- Wikipedia: Ganglion cyst
http://en.wikipedia.org/wiki/Ganglion_cyst
- Aumont EE
eMedicine (Medscape): Ganglion Cyst
http://www.emedicinehealth.com/ganglion_cyst/article_em.htm
- NEJM Knowledge+ Question of the Week.
http://knowledgeplus.nejm.org/question-of-week/3075
- Gude W, Morelli V.
Ganglion cysts of the wrist: pathophysiology, clinical picture,
and management.
Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):205-11.
PMID: 19468907 Free PMC Article
- Thornburg LE.
Ganglions of the hand and wrist.
J Am Acad Orthop Surg. 1999 Jul-Aug;7(4):231-8. Review.
PMID: 10434077
- NEJM Knowledge+