Management of the occasional wrist ganglion.

Ganglions are benign cysts that are found throughout the body, typically near a joint capsule, tendon or tendon sheath. Ganglions are more common among women than men. The typical person presenting with a ganglion is in their 3rd to 6th decade of life. However, ganglions have been reported in people between 10 years and 80 years of age. The average size is around 3 cm, but ganglion cysts up to 10 cm in diameter have been reported. They can develop suddenly or gradually, and they can disappear as fast as they came on. One study reported that 33% of dorsal ganglions and 45% of volar wrist ganglions resolve spontaneously by 6 years; and at 10 years 51% of dorsal ganglia and 63% of volar wrist ganglions spontaneously resolved. Children, particularly, have a high spontaneous resolution rate — up to 80%. Pain may be the presenting complaint, but most ganglions are painless. Pain, when present, usually suggests the cyst is putting pressure on a nerve or some other structure. Sometimes a lump may not be visible, and the only evidence the occult ganglia exists is chronic pain. Other people present because they are worried about malignancy, or they are worried about how the ganglion looks. On physical examination a ganglion typically feels smooth, fairly tense, and is fixed. It should not pulsate, and it should transilluminate if it is not too deep or too small. Differential diagnoses of a ganglion includes such things as an osteoarthritic spur, a giant cell tumour, lipoma, glomus tumour, Schwannoma, localized tenosynovitis, aneurysm, abscess and cancer. Clinical presentation and aspiration of thick, sticky, clear or slightly strawcoloured fluid using a large bore needle (18-G or larger) confirms the diagnosis. If aspiration is not possible or the ganglia is too small to palpate, ultrasound and magnetic resonance imaging can provide detailed information on size, shape, and depth of involvement. The Practitioner Le praticien