www.hand411.com www.MPSurgery.com Ganglions have been recognized since the time of Hippocrates, who suggested that they represent mucoid flesh, thus differentiating them from a ganglion of neural origin. Although much has been written about this common hand tumor, little attention has been given to flexor tendon sheath ganglions, which are often referred to as volar retinacular cysts or “sesamoid” or “pearl-seed” ganglia. The ganglion is the most common soft tissue tumor of the hand, representing approximately 50–70% of all upper extremity masses. Ganglions are usually solitary and occur in specific locations in the hand and wrist. The most common ganglion locations are the dorsal and volar wrist regions, respectively. The third most common type is a ganglion of the digital flexor tendon sheath, which has been classically described as arising from the first annular (A1) pulley. The long finger was most commonly involved, followed by the index finger, ring finger, small finger, and thumb. About half of ganglions originate from the A1 pulley. Flexor Tendon Sheath Ganglions: Results of Surgical Excision Peter J. L. Jebson & Edwin E. Spencer Jr.
www.hand411.com www.MPSurgery.com Digital mucous cysts (DMCs) are benign ganglion cysts of the digits, typically located at the distal interphalangeal (DIP) joints or in the proximal nail fold. They usually occur on the hands, although they have also been noted on the toes. The etiology of these cysts is uncertain but may involve mucoid degeneration. Often, these cysts are asymptomatic and do not require treatment. When treatment is indicated, medical therapies and surgical interventions of varying magnitudes may be attempted. Recurrence is common. Historically, little attention has been directed at studying these cysts despite their frequency. In the literature, they have been referred to as cystomata, myxomatous cutaneous cysts, myxomatous degenerative cysts, periarticular fibromas, synovial lesions of the skin, periungual ganglions, mucous cysts, myxoid cysts, synovial cysts, dorsal cysts, nail cysts, cystic nodules, digital mucoid cysts, digital myxoid cysts, and digital mucinous pseudocysts. Hippocrates first appreciated ganglion cysts, describing a knot of tissue full of fluid. In 1746, Eller concluded that ganglia formed from the herniation of the synovial lining of a joint. In 1882, Hyde first described the digital mucous cyst. In 1893, Ledderhose suggested that ganglia arose spontaneously in the subcutaneous tissue. In 1895, Ritschel proposed the earliest formulation of the theory that mucoid degeneration may be responsible for digital mucous cysts; Carp and Stout popularized the theory in 1928. Then, in 1947, Anderson reported that cysts caused the nail deformities. The mechanism of formation of digital mucous cysts is unknown. Currently, it is believed that the cysts arise from mucoid degeneration of connective tissue and that this process, in most cases, involves communication with the adjacent DIP joint and possible coexistence of osteoarthritis. Clinical and radiographic evidence of osteoarthritis is common at the site of the cysts, and the frequent presence of osteophytes and spurring of the DIP joint were recognized in the 1970s. Active connection to the joint space may or may not exist, as the mucoblasts associated with the cyst appear capable of sustaining the process. Ganglia are the most common tumor or cyst of the hand. They account for approximately 70% of all such tumors or cysts, with digital mucous cysts comprising 10-15% of the total. Women are affected more often than men (female-to-male ratio of 2-2.5:1). Source: Medscape
A ganglion cyst or synovial cyst or myxoid cyst, also known as a Bible cyst or Bible bump, is a non-neoplastic soft tissue lump that may occur in any joint, but most often occurs on or around joints and tendons in the hands or feet. It is caused by leakage of fluid from the joint into the surrounding tissue. A ganglion cyst is a noncancerous lump that most commonly develops in the wrist or hand. Some occur in the ankles or feet. If a ganglion cyst presses on a nerve, it may be painful. Depending on its location, a ganglion cyst may restrict movement. Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jelly-like fluid. This is a surgical video displaying removal of a dorsal wrist ganglion cyst. www.hand411.com www.MPSurgery.com www.mcclellanplasticsurgery.com
A ganglion cyst or wrist ganglion is a small lump which appears in the wrist, often attached to a tendon. Some are not painful but others may require treatment. If the Ganglion cyst is not painful then no treatment is necessary. It can jut be left. However if the wrist ganglion is painful or causes problems in sport then a doctor may aspirate the cyst or suck out the fluid with a needle. Injection of corticosteroid can give temporary relief and in more severe cases ganglion cyst surgery is required to completely remove the cyst. For more information visit: http://www.sportsinjuryclinic.net/sport-injuries/wrist-pain/wrist-ganglion Mr. Elliot Sorene MBBS FRCS (Tr & Orth) EDHS is Consultant Orthopaedic, Hand & Upper Limb Surgeon at the following establishments: The Hospital of St John & St Elizabeth 60 Grove End Road London NW8 9NH The London Clinic 5 Devonshire Place London W1G 6HL Spire Bushey Hospital Heathbourne Road Watford, Hertfordshire WD23 1RD To find out more about Mr. Sorene visit: http://www.londonhand.com/