Ganglion Cyst - CME Ortho
Ganglion Cyst - CME Ortho
Ganglion Cyst - CME Ortho
• Lower extremity
- most commonly about the knee /ankle
Clinical Presentation
SYMPTOMS PHYSICAL EXAMINATION
LOOK
• Usually asymptomatic - swelling/mass
• Pain/discomfort (trauma) - size (initially pea –sized)
- location
• Cosmetics issues
• Activity limitations/weakness FEEL
• Severe: neurovascular - firm, well circumscribed
manifestations - Fixed to deep tissues, not overlying skin
• Median/ulnar nerve - Non-tender
compressions (volar carpal)
• Hand ischaemia (volar carpal) MOVE
- Mild pain upon ROM
- Prominent upon flexion (dorsal carpal)
- Does not move with tendons
SPECIAL TESTS
- Transilluminative
- Allen’s test (volar carpal)
TRANSILLUMINATION TEST
• Transmission of light through a
swelling
• Roll of X-ray or paper is held on 1 side
and observed while the light is held
on the other side of the swelling
• Transillumination – POSITIVE in
swellings containing clear fluid and
thin transparent walls
• Transillumination- NEGATIVE if wall is
thick, or turbid fluid is present (blood,
pus, lymph)
• Has to be done in dark room
Differential Diagnosis
• Lipoma
• Carpal tunnel syndrome
• Extensor Tenosynovitis
• Giant cell tumor of the tendon sheath
• Pseudoaneurym (Volar carpal)
• Osteoarthritis of hand
Imaging
ULTRASOUND
X-RAY MRI
Management
CONSERVATIVE SURGICAL
• Observe
• Excision biopsy of cyst
- no neurovascular compromise
• Higher rate of resolution but
recurrence is possible
• volar ganglions have higher
recurrence after resection than dorsal
ganglions (15-20% recurrence)
• Technique:
- requires adequate exposure to
identify origin and allow resection
of stalk and a portion of adjacent
capsule
- at dorsal DIP joint: must resect
underlying osteophyte
Complications
IOF:
- ganglion cyst over dorsal aspect of wrist , extending
towards wrist joint - removed
- once removed, no pus discharge
- able to extend fingers post removal of ganglion cyst