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GANGLION


Ganglia are the most common masses seen in the hand. The word ganglion is derived from the Greek word for “knot”. Ganglia are cyst-like (balloon) structures that are filled with gel-like mucinous fluid that is very similar to joint fluid. This is also the clue that these structures originate from a joint. The joints are rather predictable and when the ganglion arises from the back of the hand it is most commonly arising from the scapho-lunate joint. When the ganglion arises from the front or palm side of the hand, it is either coming from the wrist (radio-scaphoid joint) or the STT joint (scapho-trapezio-trapezoid joint) or the radio-ulnar joint. The cyst has a thick membrane that becomes adherent to the surrounding tissue and a thick stalk that is anchored all the way down in the joint. There are grape like protrusions found at the base of this stalk on the joint capsule or ligaments that might be part of the development of this mysterious structure. The joints, from which the ganglion arise, are generally normal. We know that there is a one-way valve system that allows joint fluid from the joint into the stalk but not the other way around. Activity of the wrist creates normal circulation of the joint fluid, but also acts as a pump that ejects fluid into the ganglion. ancient

The controversial treatment of this peculiar disease was to hit the ganglion with a big Bible with the intention to burst the balloon. This brought temporary relief with high rates of recurrence. Ganglia can be aspirated with or without steroid injections. It has not been shown to reduce recurrence rates by injecting anything into it. These aspirations and injections still carry a recurrence rate of about 60%.

For patients with symptomatic and painful ganglia, surgical excision is a reasonable method of treatment. Surgical excision can be done open or arthroscopically through the wrist joint. The aim is to excise the ganglion and carefully dissect it free from all the surrounding tissue, but more importantly, to dissect the stalk down to the level of the joint to prevent recurrence. Surgical outcome is generally good with recurrence rates of less than 5%.

icon-5

GANGLIONS


Ganglia are the most common masses seen in the hand. The word ganglion is derived from the Greek word for “knot”. Ganglia are cyst-like (balloon) structures that are filled with gel-like mucinous fluid that is very similar to joint fluid. This is also the clue that these structures originate from a joint. The joints are rather predictable and when the ganglion arises from the back of the hand it is most commonly arising from the scapho-lunate joint. When the ganglion arises from the front or palm side of the hand, it is either coming from the wrist (radio-scaphoid joint) or the STT joint (scapho-trapezio-trapezoid joint) or the radio-ulnar joint. The cyst has a thick membrane that becomes adherent to the surrounding tissue and a thick stalk that is anchored all the way down in the joint. There are grape like protrusions found at the base of this stalk on the joint capsule or ligaments that might be part of the development of this mysterious structure. The joints, from which the ganglion arise, are generally normal. We know that there is a one-way valve system that allows joint fluid from the joint into the stalk but not the other way around. Activity of the wrist creates normal circulation of the joint fluid, but also acts as a pump that ejects fluid into the ganglion. ancient

The controversial treatment of this peculiar disease was to hit the ganglion with a big Bible with the intention to burst the balloon. This brought temporary relief with high rates of recurrence. Ganglia can be aspirated with or without steroid injections. It has not been shown to reduce recurrence rates by injecting anything into it. These aspirations and injections still carry a recurrence rate of about 60%.

For patients with symptomatic and painful ganglia, surgical excision is a reasonable method of treatment. Surgical excision can be done open or arthroscopically through the wrist joint. The aim is to excise the ganglion and carefully dissect it free from all the surrounding tissue, but more importantly, to dissect the stalk down to the level of the joint to prevent recurrence. Surgical outcome is generally good with recurrence rates of less than 5%.


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