Ganglion Cyst

Outpouchings of the synovium lining of joints and filled with synovial fluid

Aetiology

  • The weakness can be developmental (e.g. juvenile Baker’s cyst) or as a result of underlying joint damage/arthritis with buildup of pressure within the joint (adult Baker’s cyst, mucous cyst of DIP joint, wrist ganglion)

Pathophysiology

  • Not a true cyst as they have no epithelial lining
  • Histologically - space with myxoid material

Clinical presentation

  • Occur around a synovial joint or a synovial tendon sheath - commonly arise around the wrist, can also occur in feet and knees
  • Well-defined round swellings
  • <10mm - several cm
  • May be quite firm and readily transilluminate
  • They are usually painless/non-tender but may feel tight
  • Skin mobile, fixed to underlying structures
notion image

Investigations

  • Clinical diagnosis

Management

  • Usually resolve with time but excision may be required for localized discomfort or cosmesis
  • Needle aspiration may be attempted but recurrance is common
  • The historic treatment of striking the wrist with a heavy book ('bible technique') to burst the swelling is not advised