Ganglions Workup

Author: Anthony Schena, MD; Chief Editor: Harris Gellman, MD more...

Updated: Apr 27, 2010

What would you like to print?

Imaging Studies
Diagnostic Procedures
Histologic Findings
Show All

Multimedia Library

References

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).^{[8, 9, 10]}
- 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.^[11]

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.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Anthony Schena, MD Consulting Surgeon, ProSports Orthopedics; Associate Professor, Department of Orthopedics, Tufts Medical School

Anthony Schena, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America

Disclosure: genzyme Honoraria Speaking and teaching

Coauthor(s)

Robert Q Terrill, MD Assistant Professor, Department of Orthopedic Surgery, University of Massachusetts Medical Center

Robert Q Terrill, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter M Murray, MD Associate Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital

Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons

Disclosure: Small Bone Innovations Workshop Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas R Hunt III, MD John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham

Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association

Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None

Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

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.
Jakowski JD, Mayerson J, Wakely PE Jr. Fine-needle aspiration biopsy of the distal extremities: a study of 141 cases. Am J Clin Pathol. Feb 2010;133(2):224-31. [Medline].
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].
Ergun T, Lakadamyali H, Derincek A, Cagla Tarhan N, Ozturk A. Magnetic resonance imaging in the visualization of benign tumors and tumor-like lesions of hand and wrist. Curr Probl Diagn Radiol. Jan-Feb 2010;39(1):1-16. [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].
Gümüs N. A new sclerotherapy technique for the wrist ganglion: transcutaneous electrocauterization. Ann Plast Surg. Jul 2009;63(1):42-4. [Medline].
Edwards SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am. Mar 2009;34(3):395-400. [Medline].

Typical appearance of dorsal ganglion cyst.

View Table List