ganglion cyst; bible cyst

Etiology

• trauma or repetitive use
• flaw in joint capsule or joint sheath
• idiopathic

Epidemiology

• more common in women
• 70% occur in people between 20-40 years of age

Pathology

• contains clear fluid similar to, but thicker than, normal synovial fluid
• a type of check valve forms that allows fluid out of the joint (into the cyst), but not back into the joint
• origin of cyst is not inflammatory

Clinical manifestations

• often appears on or around joints & tendons in the hand or foot
• most frequently located around the dorsum of the wrist & on fingers, especially at the scaphoid-lunate joint, which accounts for 80% of all ganglion cysts
  • described as dorsal radiocarpal joint mass

Management

• 40-60% will spontaneously resolve
• observation for patients without pain or symptoms
• aspiration (1-3 procedures): 70-80% cure rate
• surgical resection
  • indications:
    • recurrences
    • cyst interfering with daily activities
    • intolerable pain
    • weakness
    • nerve compression
  • recurrence rate
    • 5-10% with removal of check valve at the joint capsule
    • < 5% if entire cyst complex is completely excised
• glucocorticoid not effective
• immobilization is not effective in preventing accumulation of cyst fluid & prolongs joint stiffness & limits range of motion
• closed rupture no better than observation alone & is not recommended

More general terms

• cyst