eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity
Ganglions: Workup
Updated: Apr 10, 2008
Workup
Imaging Studies
- For wrist lesions, standard posteroanterior (PA), lateral, and oblique views should be obtained.
- MRI or ultrasonography can be used when the diagnosis is in question (occult ganglions).7,8
- Mucous cysts should be evaluated with standard PA, lateral, and oblique plain radiographs of the involved digit.
- On radiographs, interosseous ganglions may be centrally or eccentrically located in the involved bone. Radiographs may also demonstrate a juxtaosseous ganglion that has penetrated the bone. The lesions are radiolucent with a sclerotic border. These ganglions usually occur near a joint surface.
- MRI reveals ganglions not seen on conventional radiographs.
- Axial, coronal, or sagittal CT scanning may be helpful in localizing occult ganglion cysts.
- Bone scans may help in determining if these intraosseous masses are metabolically active and capable of causing pain.
Diagnostic Procedures
The finger extension test is an important tool in the diagnosis of ganglions.9
Histologic Findings
Fluid evacuated from ganglion cysts consists of mucin composed of glucosamine, albumin, globulin, and hyaluronic acid.
Histologic sections of the cyst reveal compressed collagen fibers and a few flattened cells without evidence of epithelial or synovial lining. Multiple clefts may be present off the main cystic duct. No inflammatory or mitotic activity is seen.
More on Ganglions |
| Overview: Ganglions |
Workup: Ganglions |
| Treatment: Ganglions |
| Follow-up: Ganglions |
| References |
| « Previous Page | Next Page » |
References
Hooper G. Cystic swellings. In: Bogumill GB, Fleegler EJ, eds. Tumors of the Hand and Upper Limb. Churchill Livingstone;1993:172-82.
Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. Jul-Aug 1999;7(4):231-8. [Medline].
Angelides AC. Ganglions of the hand and wrist. In: Green DP, Hotchkiss RN, eds. Operative Hand Surgery. 3rd ed. Churchill Livingstone;1993:2157-71.
Oztürk K, Esenyel CZ, Demir BB, Sönmez MM, Kara AN. [Occult scapholunate ganglion in patients with dorsoradial wrist pain]. Acta Orthop Traumatol Turc. Nov-Dec 2007;41(5):349-54. [Medline].
Darcy PF, Sorelli PG, Qureshi F, Orakwe S, Ogufere W. Carpal tunnel syndrome caused by an intraosseous ganglion of the capitate. Scand J Plast Reconstr Surg Hand Surg. 2004;38(6):379-81. [Medline].
Arabori M, Kitazawa H, Akisue T, Kuroda R, Fujioka H, Doita M, et al. Intraosseous ganglion of the phalanx. Clin Imaging. Jan-Feb 2008;32(1):73-6. [Medline].
Cheng JW, Tang SF, Yu TY, Chou SW, Wong AM, Tsai WC. Sonographic features of soft tissue tumors in the hand and forearm. Chang Gung Med J. Nov-Dec 2007;30(6):547-54. [Medline].
Wang G, Jacobson JA, Feng FY, Girish G, Caoili EM, Brandon C. Sonography of wrist ganglion cysts: variable and noncystic appearances. J Ultrasound Med. Oct 2007;26(10):1323-8; quiz 1330-1. [Medline].
Kayalar M, Vatansever A, Bal E, Toros T, Ozaksar K, Ada S. [The importance of finger extension test in the diagnosis of occult wrist ganglion]. Acta Orthop Traumatol Turc. 2007;41(1):42-7. [Medline].
Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin. Feb 1995;11(1):7-12. [Medline].
Sanders WE. The occult dorsal carpal ganglion. J Hand Surg [Br]. Jun 1985;10(2):257-60. [Medline].
Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. Oct 2007;32(5):502-8. [Medline].
Further Reading
Keywords
hand tumors, wrist tumors, dorsal wrist ganglions, ganglion cyst, occult dorsal ganglions, volar wrist ganglions, intraosseous ganglion cysts
Workup: Ganglions