What is it?
A ganglion cyst is a fluid filled sac that emanates from a joint or a tendon sheath. In the hand and wrist they typically occur on the back or front of the wrist, at the fingertips, or along the flexor tendons of the fingers.
What causes them?
Partial defects in the joint capsule or sheath can allow fluid within to be expressed outwards through a one-way valve type mechanism, resulting in fluid being trapped within a wall of expansile tissue.
What are the symptoms?
Ganglion cysts will cause focal areas masses overlying the structures they emanate from. These masses may increase and decrease over time. While cysts can be painless, depending on location, size, and growth, they may cause pain or may cause cosmetic concerns. They are often brought to the attention of medical professionals because of concern of malignancy.
How are they diagnosed?
The appearance, location, and exam characteristics are sufficient to diagnose a ganglion cyst with a high degree of certainty. When in question, an ultrasound or MRI can be used to confirm the diagnosis or rule out other causes, such as vascular lesions or tumors.
How are they treated?
Because ganglions are benign masses, simple observation is a reasonable treatment if they cause no pain, discomfort or cosmetic concern. Some cysts may resolve on their own. Options to address a cyst include aspiration and surgical removal. With surgery, an incision is made over the cyst and dissection is taken down to the joint or tendon sheath of origin to remove the cyst. Sometimes this can be performed through an arthroscopy. The other option is an aspiration, which involves draining the cyst with a needle to decompress it. While this is simpler to perform and can be done in the clinic setting, there is a substantially higher risk of recurrence of the mass compared to surgery.
Ligament repair / reconstruction
Ligaments guide and restrict the motion of joints, helping to provide the stability necessary for function. Injuries to ligaments can disrupt those critical functions and preclude normal and pain free function. Injuries to ligaments range from from sprains, to partial tears, to full tears. In the fingers, the Examples of commonly injured and treated ligaments include the MCP ligament of the thumb.
Most low grade ligament injuries can be treated with immobilization and rest to allow healing. More severe tears or complete ruptures may require surgery to restore the ligament to its anatomic location to allow it to heal in the right position and function appropriately. During surgery, an incision will be made over the joint. The ligament is repaired usually with the use of an anchor placed into the bone. Sometimes the quality of tissue remaining is insufficient for repair. In this case, the ligament may have to be reconstructed instead of repaired by using a graft tissue, such as a tendon, to take its place.
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