AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

Ganglions are among the most common tumors of the hand and wrist. For the most part, they are asymptomatic masses that are primarily cosmetic rather than functional disturbances. In most instances, observation is the only management necessary. However, some ganglions can exert a mass effect on nearby structures, such as arteries, veins, tendons, and nerves. The impingement of such structures can cause pain, triggering of tendons, and vascular compromise. In these instances, the patient often seeks surgical attention.^{1, 2, 3}

Related eMedicine topics:
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Ganglion Cyst
Hand, Tumors: Benign - Plastic Surgery

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History of the Procedure

People have been seeking treatment for ganglions for many centuries. Historically, treatment consisted of crushing the ganglion with a heavy object (eg, a Bible). Often, a firm strike with a heavy object was all that was needed to cure the patient. Now, simple observation, aspiration, and surgical excision are the treatment modalities of choice.

Problem

Many ganglions can be managed with mere observation. However, each type of ganglion can cause local symptoms depending on its anatomic location.

Frequency

Ganglions in general represent 50-70% of all soft-tissue tumors of the hand and wrist. The prevalence in women is 3 times greater than that in men. Most ganglions occur in persons aged 10-40 years, with a range from childhood to the ninth decade of life.

These tumors may occur in a variety of locations. Mucous cysts are ganglions of the distal interphalangeal (DIP) joint that occur primarily in persons aged 40-70 years. These also occur more commonly in females than in males.

Etiology

The etiology of ganglions is unknown. Theories include mucoid degeneration and trauma. Some patients (<10%) recall minor or major trauma to the area prior to development of the mass. No known occupational risk factors exist. Mucous cysts and some other ganglions are associated with degenerative joint disease.

Pathophysiology

Hippocrates described ganglions as "knots of tissue containing mucoid flesh." Since this description, several hypotheses have been proposed. These include the following:

• Synovial herniation or rupture through the tendon sheath (Eller, 1746)
• Synovial dermoid or rest due to "arthrogenesis blastoma cell nests" or embryonic periarticular tissue (Hoeftman, 1876)
• New growths from synovial membranes (Henle, 1847)
• Modifications of bursae or degenerative cysts (Vogt, 1881)

The theory of mucoid degeneration offered by Ledderhose in 1893 was widely accepted. In Green's most recent edition of Operative Hand Surgery, however, this theory is replaced with a theory based on microtrauma and hyaluronic acid production.³ Local tissue trauma or irritation is postulated to cause production of hyaluronic acid at the synovial-capsular interface. The hyaluronic acid creates small mucin lakes that coalesce into subcutaneous cysts with stalks or ganglions.

Clinical

Ganglions are tumors that present adjacent to joints or tendons. The most common sites for ganglions are the dorsal aspect of the wrist near the scapholunate (SL) joint (60-70%), the volar wrist near the radioscaphoid joint or the pisotriquetral joint (18-20%), and the volar retinaculum between the A1 and A2 pulleys (10-12%). Mucous cysts occur over the dorsal digit at the DIP joint level. Other sites include the carpometacarpal (CMC) joint, the extensor tendons (especially associated with the first dorsal compartment), the carpal tunnel, and the Guyon canal. Ganglions may also arise within bone; these are called intraosseous ganglion cysts.

Ganglions are usually minimally symptomatic. However, depending on the location of the cyst, patients may present with a myriad of symptoms such as dull aching pain, change in size, spontaneous drainage, and sensory nerve dysfunction. Specific symptoms for each type of ganglion are described next.

Dorsal wrist ganglions

Dorsal wrist ganglions typically present in proximity to the SL interosseous ligament. Approximately 75% of dorsal wrist ganglions are connected to the radiocarpal joint through a stalk from the SL ligament. Some ganglions may present at a site distant to the SL ligament, but they are attached to the ligament by a long pedicle. Careful palpation over the cyst and pedicle often reveals the extent of the cyst and the direction in which it is traveling. Most are asymptomatic masses that change in size. Some patients may present with pain and tenderness due to compression of the posterior interosseous nerve (PIN) or the superficial radial nerve. The mass itself is compressible, subcutaneous, transilluminating, and slightly mobile without associated skin changes.

Differential diagnoses include the following:

• Tenosynovitis
• Infection
• Extensor digitorum brevis manus muscle belly
• Proximal pole of scaphoid (dorsiflexed intercalated segment instability [DISI])
• Proximal pole of lunate (volar-flexed intercalated segment instability [VISI])
• Scaphotrapezial arthritis
• CMC boss
• Venous aneurysm
• Lipoma
• Neuroma
• Hamartoma
• Sarcoma

Occult dorsal ganglions

Patients with occult ganglions can present with the same symptoms as those with dorsal ganglions without a clinically evident mass. These ganglions are small and not palpable. Patients often experience pain, and these lesions may go undiagnosed for extended periods.⁴

Volar wrist ganglions

Two thirds of volar wrist ganglions come from the radioscaphoid joint and the remaining third from the scaphotrapezial joint. They rarely occur at the pisotriquetral joint. The cyst usually appears between the radial artery and the flexor carpi radialis (FCR). The cyst appears small clinically, but considerable extension may be found at the time of surgery. These ganglions have been found to track along the thenar muscles or along the FCR, they may extend into the carpal tunnel, and they have multiple appendages intertwined with the radial artery.

Patients present with pain and/or tenderness at the site of the ganglion and a palpable cyst. They may have sensory symptoms (palmar cutaneous branch of the median nerve) or, less commonly, motor nerve dysfunction.

Differential diagnoses include the following:

• Tenosynovitis
• Infection
• Carpal osteoarthritis
• Lipoma
• Sarcoma
• Radial artery aneurysms or arteriovenous malformations
• Hamartoma
• Intraneural cysts

Volar retinacular ganglion

Volar retinacular (flexor tendon sheath) ganglion arises from the A1 or A2 pulley of the flexor tendon sheath and presents as a small (3 to 10 mm), firm, tender, and mobile mass near the proximal digital crease or the metacarpophalangeal (MCP) joint. The mass does not move with the tendon. Patients may have associated paresthesias of the involved digit secondary to pressure on the digital nerve. The lesion may also be associated with stenosing tenosynovitis. The diagnosis is made based on physical examination findings.

Differential diagnoses include the following:

• Epidermoid inclusion cyst
• Giant cell tumor of the tendon sheath
• Foreign-body granuloma
• Lipoma
• Trigger finger
• Neurilemoma

Mucous cyst

The mucous cyst may be heralded by a groove in the nail bed and usually presents as a 3- to 5-mm cyst eccentrically located at the DIP between the dorsal distal joint crease and the eponychium. The mass is firm, is minimally mobile, and can be transilluminated. Mucous cysts are associated with Heberden nodes and osteophytes. A mucous cyst may be ruptured on presentation.

Differential diagnoses include the following:

• Heberden nodes
• Gout
• Giant cell tumor of the tendon sheath

CMC boss

This lesion is not a true ganglion cyst but a large spur that develops most frequently at the base of the second and third CMC joints in response to osteoarthritis. It appears as a firm, bony, nonmobile, tender mass on the dorsum of hand. Many patients are asymptomatic. Others may experience dull aching pain. A palpable ganglion is associated with a boss in 30% of cases. Some consider trauma to be the cause of the lesion.

Proximal interphalangeal joint ganglion

A proximal interphalangeal (PIP) ganglion is similar to the mucous cyst of the DIP. A 3- to 5-mm mass arises along either side of the extensor tendon at the PIP joint. Usually, the mass pierces through the oblique fibers between the central slip and the lateral band. Patients may present with pain and limited range of motion.

Extensor tendon ganglion

The extensor tendon ganglion primarily occurs dorsally over the metacarpal joints as a subcutaneous mass. It can be tender and cause a dull ache, as well as snapping of the tendon with motion.

Differential diagnoses include the following:

• Giant cell tumor of the tendon sheath
• Tenosynovitis
• Extensor digiti brevis manus muscle belly
• Dorsal wrist ganglion
• CMC boss

Dorsal retinacular ganglion

This ganglion lies within the first dorsal compartment and often is associated with de Quervain stenosing tenosynovitis. The ganglion is attached to the first dorsal extensor compartment.

Carpal tunnel ganglion

Ganglions can arise within the carpal tunnel, compressing the median nerve and causing carpal tunnel syndrome. Some of the volar wrist ganglions have been known to extend into the carpal tunnel as well.⁵

Ulnar canal ganglions

Ganglions within the Guyon canal can cause compression of the ulnar nerve, causing sensory and motor disturbances. These ganglions seem to arise form the hamate and travel through the hypothenar muscles to the canal. These ganglions can cause atrophy of the interosseous muscles by compressing the motor branch of the ulnar nerve. When suspected, these ganglions should be removed early to prevent permanent damage.

Intraosseous ganglion cysts

These ganglions represent rare incidental radiographic findings. They can, however, be a cause of dull, aching wrist pain. When discovered, all other possible diagnoses should be pursued prior to diagnosing an intraosseous ganglion as the source of the wrist pain. The scaphoid and lunate are most commonly affected. Interosseous ganglions also are known to occur in the other carpal bones, metacarpals, phalanges, and distal ulna. They may have an etiology distinctly different from that of soft-tissue ganglions.⁶

Differential diagnoses include the following:

• Simple bone cyst
• Aneurysmal bone cyst
• Osteoid osteoma
• Osteoblastoma
• Enchondroma
• Chondroblastoma
• Giant cell tumor
• Nonossifying fibroma
• Chondromyxoid fibroma

INDICATIONS

Section 3 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

All of the ganglions described above are benign lesions. For most patients, observation, reassurance, or aspiration and/or injection suffice for treatment. However, in some cases, ganglions cause enough discomfort or dysfunction that surgical treatment is desired by the patient. In these cases, the ganglion may be situated close to a sensory or motor nerve, but more commonly, the pain results from the mass effect. In patients presenting with skin breakdown, nail deformity, or repeated episodes of drainage caused by DIP joint mucous cysts, surgical treatment should be considered.

RELEVANT ANATOMY

Section 4 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

See Clinical.

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

Imaging Studies

• For wrist lesions, standard posteroanterior (PA), lateral, and oblique views should be obtained.
• MRI or ultrasonography can be used when the diagnosis is in question (occult ganglions).^{7, 8}
• • Mucous cysts should be evaluated with standard PA, lateral, and oblique plain radiographs of the involved digit.
• On radiographs, interosseous ganglions may be centrally or eccentrically located in the involved bone. Radiographs may also demonstrate a juxtaosseous ganglion that has penetrated the bone. The lesions are radiolucent with a sclerotic border. These ganglions usually occur near a joint surface.
• MRI reveals ganglions not seen on conventional radiographs.
• Axial, coronal, or sagittal CT scanning may be helpful in localizing occult ganglion cysts.
• Bone scans may help in determining if these intraosseous masses are metabolically active and capable of causing pain.

Diagnostic Procedures

The finger extension test is an important tool in the diagnosis of ganglions.⁹

Histologic Findings

Fluid evacuated from ganglion cysts consists of mucin composed of glucosamine, albumin, globulin, and hyaluronic acid.

Histologic sections of the cyst reveal compressed collagen fibers and a few flattened cells without evidence of epithelial or synovial lining. Multiple clefts may be present off the main cystic duct. No inflammatory or mitotic activity is seen.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

Medical therapy

For wrist ganglions, initial therapy may consist of simple splint immobilization and nonsteroidal anti-inflammatory drugs (NSAIDs). Closed rupture (by a sharp blow with a heavy object) is associated with a 22-66% recurrence rate and is inappropriate in-office treatment. One wrist fracture was reported from a direct blow.^{1, 2, 3, 10, 11, 12}

Multiple punctures with a needle preceded by the administration of a local anesthetic is associated with a 13% cure rate. The cure rate increases to 40% if splinted for 3 weeks after one aspiration or puncture. This rate increases to 85% after 3 sessions. The addition of injectable steroids has no apparent benefit. Treatment by suturing the lesion externally is associated with a 95% 6-month cure rate but an unacceptable rate of infection. The patient should be reassured that these are benign cysts and rarely cause much disability.

Management for occult dorsal ganglions is similar to that of dorsal ganglions. Aspiration can be accomplished with sonographically guided needle placement, but surgical excision is sometimes necessary.

Caution must be exercised in the aspiration of volar radial lesions because of the proximity of the radial artery. This procedure, especially when combined with the injection of steroids, is not recommended.

For volar retinacular (flexor tendon sheath) ganglions, needle rupture followed by steroid injection and digital massage may work in as many as 70% of patients. Digital nerve injury is a reported complication. Needle rupture in these cysts on the radial or ulnar aspect relative to the midline is risky for this reason.

Observation is also appropriate for mucous cysts. Aspiration with or without steroids has been associated with a recurrence rate of as high as 50%. This and other methods commonly used by dermatologists (freezing, etc) are associated with a risk of septic arthritis.

Nonsurgical management for CMC boss, PIP joint ganglions, extensor tendon ganglions, and intraosseous ganglions consists of observation.

Surgical therapy

The most accepted surgical treatment for ganglion cyst involves removal of the masses with an open surgical technique.^{1, 2, 3, 10, 11, 12}

Arthroscopic resection of dorsal ganglions has become popular over the past 10 years. Use of the arthroscope affords the surgeon the added benefit of completely evaluating the joint.¹⁰

Preoperative details

For volar wrist ganglion, the patency of the patient's radial and ulnar arteries should be preoperatively assessed with an Allen test. This test is important because the volar wrist ganglion may interdigitate with the radial artery. In some instances, the radial artery may need to be repaired or even ligated. A standard complete hand and wrist examination, including a range-of-motion assessment, a strength assessment, and neurologic function testing, should be performed preoperatively.

Intraoperative details

Dorsal ganglions can be approached through a transverse or longitudinal dorsal wrist incision. A smaller secondary incision may be required if the ganglion lies elsewhere but its stalk is attached to the SL ligament. The ganglion usually resides between the extensor pollicis longus (EPL) and extensor digitorum communis (EDC) tendons.

The main cyst and pedicle are mobilized down to the dorsal wrist capsule, which is opened along the border of the radius and scaphoid. The ganglion and its capsular attachments then are excised from the SL ligament, taking great care to avoid injury to that ligament. A limited synovectomy is performed, and the joint is thoroughly irrigated. The resected tissue is submitted for pathologic analysis to confirm the diagnosis. The capsule is not closed, and the skin is sutured after the tourniquet is released and hemostasis obtained. A bulky, mildly compressive dressing with or without a volar splint is applied.

Dorsal wrist ganglions

The arthroscope is set up with a tower and finger traps to provide 10-12 lb of distraction across the wrist. General or regional anesthesia can be used. A tourniquet should be applied above the elbow in case the surgeon needs to convert to an open procedure.

First, an arthroscopic examination of the wrist joint is performed with the arthroscope placed in the 3-4 portal, and a blunt probe is placed in the 4-5 portal. Once the ganglion cyst is identified and localized, the arthroscope is placed in the 6R portal, and a full radius resector is placed through the 3-4 portal. Often, the 18-gauge needle used to establish the 3-4 portal pierces the ganglion. The ganglion often appears as a pearl suspended from the dorsal capsule (61% of cases). The ganglion is resected from the dorsal capsule and the SL ligament.

Caution must be used to prevent damage to the SL ligament and overlying extensor tendons. The portals are closed with simple sutures, and the wrist is placed in a volar splint. Use of the midcarpal portals facilitates the removal of ganglions that emanate from the confluence of the capitate, lunate, and scaphoid.

Occult dorsal ganglions

Occult dorsal wrist ganglions are excised through a transverse or longitudinal dorsal wrist incision, depending on the location of the lesion.

Volar wrist ganglions

The approach to the excision of a volar ganglion must allow for extension into the carpal tunnel or thenar muscles. A serpiginous incision centered on the ganglion, usually just radial to the FCR tendon, is used. Care must be used to protect the radial artery, the lateral antebrachial cutaneous nerve, and the superficial radial nerve. The radial artery must be dissected free from the cyst and its appendages. This step may require leaving a wall of the cyst attached to the radial artery.

The FCR is released from its sheath and retracted in an ulnar direction. The palmar cutaneous branch of the median nerve lies on the ulnar side of this tendon in approximately 90% of patients. The ganglion then is tracked down to the volar capsule and excised with a ring of capsule. The volar carpal ligaments should be protected. A limited synovectomy is performed, and the joint is thoroughly irrigated. The capsule should not be closed. After the tourniquet is released and hemostasis is obtained, the skin is closed, and a bulky dressing is applied with or without a splint.

For ulnar-sided ganglions, a longitudinal incision is used along the flexor carpi ulnaris (FCU) tendon. The ulna neurovascular bundle should be identified and retracted in a radial direction while the FCU is retracted in an ulnar direction. The dorsal sensory branch of the ulnar nerve should be identified and protected during proximal dissection. Because many of these cysts arise from the pisotriquetral joint, the Guyon canal may need to be opened and its contents protected, for adequate exposure and resection of the stalk. Once excised, the incision is closed as noted previously.

Volar retinacular ganglions

With volar retinacular (flexor tendon sheath) ganglions, a Bruner incision is used to dissect the mass and tendon sheath. Both digital bundles should be identified and protected. The mass and a small part of the tendon sheath are excised. The tendon sheath is not repaired, and the skin is sutured. A bulky dressing is applied, and early unrestricted motion is allowed.

Mucous cysts

Multiple incisions have been described for resection of the cyst. What is clear is that excision of the skin overlying the cyst, and subsequently a skin graft, is not necessary. Generally, any skin defect that remains heals readily by secondary intention. The incision for a mucoid cyst is performed at the level of the joint not over the cyst itself. Generally, a simple transverse incision at the joint level suffices. A curved L-shaped incision or an H-shaped incision allows wider access to the cyst and the underlying osteophytes.

Care must be taken not to injure the germinal matrix, which may extend more than 5 mm proximal to the eponychial fold. Also, the insertion of the terminal extensor tendon is left intact. The joint is approached through a longitudinal incision just radial or ulnar to the extensor tendon. Repairing this incision during closure is not necessary. The cyst, stalk, dorsal capsule, synovium, and all associated osteophytes must be removed. An extension splint is used for 10-14 days.

Proximal interphalangeal joint ganglions

A longitudinal incision is made over the PIP joint. The lateral band is released from the transverse ligament and retracted dorsally. The ganglion and its pedicle are traced to the capsule through the extensor system. A small elliptical incision through the oblique fibers is usually necessary to mobilize the ganglion. The joint capsule and synovial lining between the collateral ligament and the extensor insertion on the middle phalanx are excised. The skin is closed, and a soft dressing or short-term splint is applied. Early motion is recommended.

Extensor tendon ganglions

A transverse incision is made over the mass. The ganglion is mobilized and dissected off the extensor tendon, and it is stalk traced to the adjacent MCP joint. Nearby synovial tissue is removed, as well as an ellipse of capsular tissue from the MCP joint where the stalk originates. The skin is closed, and early motion is recommended. Recurrence is rare.

Dorsal retinacular ganglions

The ganglion lies within the first dorsal compartment. The first compartment is appropriately released and explored, and the ganglion is excised.

Carpal tunnel ganglions

Ganglions can arise within the carpal tunnel, compressing the median nerve and causing carpal tunnel syndrome. Some of the volar wrist ganglions have been known to extend into the carpal tunnel as well. In either instance, when the carpal tunnel is being released, the ganglion, if present, should be removed.

Ulnar canal ganglions

Ganglions within the Guyon canal can cause compression of the ulnar nerve, resulting in sensory and motor disturbances. These ganglions seem to arise form the hamate and travel through the hypothenar muscles to the canal. These ganglions can cause atrophy of the interosseous muscles by compressing the motor branch of the ulnar nerve. When suspected, these ganglions can be imaged by means of MRI prior to Guyon canal exploration.

Interosseous ganglions

In cases in which the patient is experiencing pain and in which all other sources for the pain are excluded, surgical treatment of these ganglions may be undertaken. When indicated, curettage and bone grafting of the lesion are performed. At the time of the surgery, the joints of the involved bone should be explored to rule out other sources for the patient's symptoms.

Postoperative details

With dorsal wrist ganglions, a volar wrist splint is applied postoperatively. The splint and dressing are removed between postoperative days 10 and 14. Early motion is encouraged. Sutures are removed on postoperative day 14, and physical therapy continues until the full range of motion and strength is achieved.

The postoperative care for most of the other types of ganglions is similar to that described above. Infected mucous cysts may be left open, and wet-to-dry dressing changes may be required.

Follow-up

Patients are followed up for approximately 2 months after surgery to ensure their full return to activities. The surgeon must check the final pathologic report about the nature of the tissue removed at the time of ganglion excision.

For excellent patient education resources, visit eMedicine's Hand, Wrist, Elbow, and Shoulder Center. Also, see eMedicine's patient education articles Ganglion Cyst and Carpal Tunnel Syndrome.

COMPLICATIONS

Section 7 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

The most common complication with the surgical treatment of dorsal ganglions is recurrence secondary to inadequate or incomplete resection. If the cyst returns many years after treatment, it most likely represents a new ganglion. Stiffness can occur, particularly the loss of volar flexion if early motion is not initiated or if the patient remains in a splint for too long. Neuromas can occur if the sensory branches of the radial or ulna nerves are damaged. Perhaps the most devastating complication is iatrogenic SL ligament injury.

With volar wrist ganglions, neuromas can arise from branches of the radial sensory nerve, the lateral antebrachial cutaneous nerve, and the palmar cutaneous branch of the medial nerve. Injuries to the radial artery that result in primary ligation have not been reported to cause long-term morbidity. However, Green advocates primary repair of the artery. Recurrence rates are higher for these ganglions (33%) than for others, most likely because of inadequate stalk resection.³

Regarding volar retinacular (flexor tendon sheath) ganglions, injury to the digital bundles has been reported, and recurrences are rare.

With mucous cysts, recurrences may be secondary to incomplete excision of the stalk, capsule, or associated DIP joint osteophyte. However, reformation of the mass is usually the result of the development of a new cyst, not recurrence of the previous cyst. Skin complications are not unusual. Loss of terminal DIP joint extension may occur if the insertion of the extensor tendon is disturbed.

OUTCOME AND PROGNOSIS

Section 8 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

Given that ganglions are benign lesions, the overall prognosis is excellent with open surgical treatment. Recurrence rates of 10-15% are typically reported. Excision of the cyst with a small ring of capsule has been shown to reduce the recurrence to 4% when compared with resection of the cyst alone (13-40%).

Osterman and Raphael found that arthroscopic treatment was also safe and reliable.¹⁰ They had recurrences equal to those reported with open procedures. Arthroscopic resection also resulted in smaller surgical scars.

Sanders reported dramatic improvement of function and relief of pain in selected patients who had a suspected occult ganglion.¹¹

FUTURE AND CONTROVERSIES

Section 9 of 10  

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

Currently, the only controversial treatment for dorsal wrist ganglions is arthroscopy. Many articles support the use of the arthroscopy for ganglion excisions.

REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Indications
• RELEVANT ANATOMY
• Workup
• Treatment
• Complications
• Outcome and Prognosis
• Future and Controversies
• References

1. Hooper G. Cystic swellings. In: Bogumill GB, Fleegler EJ, eds. Tumors of the Hand and Upper Limb. Churchill Livingstone;1993:172-82.
2. Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. Jul-Aug 1999;7(4):231-8. [Medline].
3. Angelides AC. Ganglions of the hand and wrist. In: Green DP, Hotchkiss RN, eds. Operative Hand Surgery. 3rd ed. Churchill Livingstone;1993:2157-71.
4. Oztürk K, Esenyel CZ, Demir BB, Sönmez MM, Kara AN. [Occult scapholunate ganglion in patients with dorsoradial wrist pain]. Acta Orthop Traumatol Turc. Nov-Dec 2007;41(5):349-54. [Medline].
5. Darcy PF, Sorelli PG, Qureshi F, Orakwe S, Ogufere W. Carpal tunnel syndrome caused by an intraosseous ganglion of the capitate. Scand J Plast Reconstr Surg Hand Surg. 2004;38(6):379-81. [Medline].
6. Arabori M, Kitazawa H, Akisue T, Kuroda R, Fujioka H, Doita M, et al. Intraosseous ganglion of the phalanx. Clin Imaging. Jan-Feb 2008;32(1):73-6. [Medline].
7. Cheng JW, Tang SF, Yu TY, Chou SW, Wong AM, Tsai WC. Sonographic features of soft tissue tumors in the hand and forearm. Chang Gung Med J. Nov-Dec 2007;30(6):547-54. [Medline].
8. Wang G, Jacobson JA, Feng FY, Girish G, Caoili EM, Brandon C. Sonography of wrist ganglion cysts: variable and noncystic appearances. J Ultrasound Med. Oct 2007;26(10):1323-8; quiz 1330-1. [Medline].
9. Kayalar M, Vatansever A, Bal E, Toros T, Ozaksar K, Ada S. [The importance of finger extension test in the diagnosis of occult wrist ganglion]. Acta Orthop Traumatol Turc. 2007;41(1):42-7. [Medline].
10. Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin. Feb 1995;11(1):7-12. [Medline].
11. Sanders WE. The occult dorsal carpal ganglion. J Hand Surg [Br]. Jun 1985;10(2):257-60. [Medline].
12. Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. Oct 2007;32(5):502-8. [Medline].

Article Last Updated: Apr 10, 2008