A 72-year-old woman presented for evaluation of a large swelling on her dorsal wrist, which had been present for 2 years. The protuberance was not painful or tender; the patient was otherwise in good health. Joe Monroe, PA-C, of Tulsa, Okla, writes that ganglion cysts result from myxomatous degeneration—possibly caused by antecedent trauma— that occurs in a portion of the connective tissue of the joint capsule.
Although ganglia feel firm, they are filled with a clear, extremely viscous gelatinous fluid. The cysts may become large enough to cause discomfort or even nerve compression. Ganglia frequently develop above the scapholunate articulation, as in this patient; however, they also can occur on the dorsa of the feet and on the radial aspect of the wrist.
Although the differential includes neoplasia, ganglion cysts are so common and characteristic in these locations that the diagnosis is usually obvious. An otoscope can be used to confirm translucence and rule out solid tumors. Ganglion cysts are often untreated. For patients who are in pain or unhappy with the cyst's appearance, treatment options include evacuation through a large-gauge needle, intralesional injection with triamcinolone (10 to 20 mg/mL), and surgical removal. Evacuation can reduce the size and prominence of the cyst, lessen symptoms, and confirm the diagnosis by the appearance and thickness of the fluid. This patient chose to live with her cyst, since it was stable and asymptomatic.