History and exam

Key diagnostic factors

common

subcutaneous wrist mass

Dorsal cysts are usually located near and distal to the Lister tubercle. Volar cysts are usually located between the flexor carpi radialis tendon and the radial artery.

Diameter is typically between 1 to 4 cm, although can reach up to 8 cm.

Characteristics include being smooth and slightly mobile with no connections to underlying tendons.

wrist pain

Patients may experience occasional aching discomfort secondary to compression of surrounding structures. In some patients, this aching is only present after activity.

Occult ganglia are usually undetectable by physical examination but may be a cause of vague wrist pain.

Dorsal ganglia may compress the posterior interosseous nerve and cause pain in the wrist region.[14]

nontender mass

There is usually minimal to no pain on palpation unless the cyst is overlying neurological structures.

increased mass size after activity

Ganglion mass can often increase temporarily with strenuous activity of the involved extremity, and return to baseline after rest.

transilluminating mass

Typical reddish glow of a fluid-filled cyst is observed when a penlight is held next to the cyst.

[Figure caption and citation for the preceding image starts]: Transillumination of ganglion cyst using pentorchBotte MJ et al. Musculoskeletal Key. Available at: https://musculoskeletalkey.com/ganglion-excision; used with permission; cited from Green DP et al. Green’s Operative Hand Surgery. 4th ed. New York: Churchill-Livingston, 1999: 2171-83 [Citation ends].com.bmj.content.model.Caption@45e64dae

Other diagnostic factors

common

unable to recall onset of lump

Patients do not usually remember when the mass began.

uncommon

hand or finger coolness

Compression of the radial artery can lead to compromised blood flow to the radial side of the hand.

paresthesia or weakness of fingers

Patients may describe altered hand/finger sensation if there is compression of neurologic structures.

reduced sensation in the hand

Dorsal ganglia may compress the superficial radial nerve causing reduced sensation on the dorsum of hand.[14]

Volar ganglia may compress the ulnar nerve causing reduced sensation of the small and ring fingers.[15]

Volar ganglia may also compress the median nerve mimicking carpal tunnel syndrome.[15]

Risk factors

weak

female sex

They are more likely to be present in women (female to male ratio is 3:1).[2]

In children, the female to male ratio is 1.4:1 to 1.8:1.[3][4]

age 10 to 30 years

The condition usually affects patients in their second to fourth decades, but can be present at any age.[5]

trauma

When questioned about injuries, anywhere from 10% to 40% of patients may recall a specific traumatic event prior to the appearance of the ganglion.[7]

A definitive link between traumatic injuries of the wrist joint and resultant ganglion formation has not yet been confirmed.

scapholunate instability

As the “stalk” of wrist ganglia almost always arises at the scapholunate ligament, injury or disruption of this ligament has been postulated as a cause of dorsal cyst formation.[8] There have been reports of chronic injuries to the scapholunate ligament in patients with persistent pain after ganglion excision. However, there is no definitive link; most patients with ganglions do not have any signs or symptoms of scapholunate instability or injury.

Use of this content is subject to our disclaimer