Ganglion Cyst
Ganglion Cysts are the most common soft tissue tumors of the hand (60-70%). They are mucin-filled cysts arising from a joint capsule or tendon sheath.
[Image of Ganglion Cyst Wrist]1. Common Locations
- Dorsal Wrist (60-70%): Arises from the Scapholunate (SL) ligament. Becomes prominent with wrist flexion.
- Volar Wrist (20%): Arises from the Scaphotrapezial or Radiocarpal joint. Caution: Often close to Radial Artery.
- Flexor Tendon Sheath (Volar Retinacular Cyst): Base of finger ("Pearl ganglion").
2. Management
- Observation: 50% resolve spontaneously.
- Aspiration: Draining the fluid. High recurrence rate (50%).
- Surgical Excision: Removal of cyst + stalk + part of capsule. Recurrence rate 5-10%.
- "Bible Therapy": Smashing with a heavy book (Historical/Dangerous - do not do this!).
25 Practice MCQs
Q1. The most common site for a ganglion cyst is:
Answer: A). Specifically over the Scapholunate interval.
Q2. The fluid inside a ganglion is:
Answer: B). Hyaluronic acid rich.
Q3. Dorsal wrist ganglions usually arise from:
Answer: A). The stalk originates here.
Q4. Transillumination test for ganglion is:
Answer: A). Distinguishes cystic from solid tumors.
Q5. Occult dorsal ganglion can cause:
Answer: A). Detected by MRI or Ultrasound.
Q6. Volar wrist ganglions are risky to aspirate/excise because of:
Answer: A). Often intertwined with the artery.
Q7. Mucous Cyst is a ganglion found at the:
Answer: A). Can cause nail deformity.
Q8. Allen's Test should be performed before surgery on:
Answer: A). To ensure ulnar artery supply is adequate if radial artery is damaged.
Q9. Recurrence rate after Aspiration is roughly:
Answer: B). The stalk remains and refills.
Q10. "Bible Cyst" refers to:
Answer: A). Not recommended!
Q11. Ganglions are most common in:
Answer: A). Benign condition.
Q12. Is the lump fixed or mobile?
Answer: A). Anchored to the joint capsule.
Q13. Volar Retinacular Cyst causes pain during:
Answer: A). Like walking on a pebble.
Q14. Does a ganglion malignant transformation occur?
Answer: B). Purely benign.
Q15. Sudden rupture can occur with:
Answer: A). Fluid disperses into tissue.
Q16. Surgical excision aims to remove:
Answer: A). Removing the root reduces recurrence.
Q17. Dorsal wrist ganglions become MORE prominent with:
Answer: A). Stretches the dorsal capsule, popping the cyst out.
Q18. Complication of dorsal ganglion surgery includes:
Answer: A). Ligament damage is a risk.
Q19. An intra-osseous ganglion is:
Answer: A). Causes deep aching pain.
Q20. Post-op immobilization is usually:
Answer: A). To prevent stiffness.
Q21. A "Carpal Boss" is:
Answer: A). Often hard and immobile; mistaken for ganglion.
Q22. Arthroscopic excision is possible for:
Answer: A). From inside the radiocarpal joint.
Q23. Is ultrasound useful?
Answer: A). Cost-effective imaging.
Q24. Why do ganglions form?
Answer: A). Theories vary but valve mechanism (fluid in, not out) is popular.
Q25. Spontaneous resolution is most common in:
Answer: A). Up to 70% in kids resolve.
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