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An Atlas of Lumps and Bumps, Part 46: Ganglion Cysts

Alexander K.C. Leung, MD, MBBS, FRCPC, FRCP
Benjamin Barankin, MD, FRCPC
Joseph M. Lam, MD
Alex H.C. Wong, MD
Kin Fon Leong, MD
Volume 64 - Issue 12 - December 2024

Ganglion Cysts

A ganglion cyst is a benign cystic swelling that typically arises from the synovium of either a tendon sheath or a joint capsule.1 The cyst contains a clear, gelatinous, colloid material, or a thick mucinous fluid.2 The latter contains hyaluronic acid and other mucopolysaccharides. The fluid is surrounded by a dense network of collagen fibers and fibrocytes.

It is believed that ganglion cysts result from repetitive microtrauma leading to mucinous degeneration of connective tissue of the tendon.2,3 The condition is more frequently observed among gymnasts.2 Ganglion cysts seldom result from herniation of synovial tissue from within the joints; the incidence of intra-articular lesions has been reported to be 0.2 to 1.6% on magnetic resonance imaging.4 On the other hand, ganglion cysts may arise from the leakage of synovial fluid as a post-operative complication of arthroscopy.5

Ganglion cysts are relatively common, although the exact incidence is not known. They account for 57% to 70% of soft-tissue masses found in the hand and wrist.2,6 Although ganglion cysts can form at any age, the peak incidence is between the 20 and 50 years of age.2 The female to male ratio is approximately 3 to 1.2

Clinically, a ganglion cyst presents as a firm, well circumscribed, freely mobile cystic mass adjacent to a tendon or joint (Figure 1).2

A ganglion cyst presents as a firm, well circumscribed, freely mobile cystic mass adjacent to a tendon or joint.
Figure 1. A ganglion cyst presents as a firm, well circumscribed, freely mobile cystic mass adjacent to a tendon or joint.

The most common sites include the dorsum of the wrist (70%) followed by the volar side of the wrist (20%), the hand, the dorsum of the ankle, and the foot although ganglion cysts may occur anywhere on the body.7,8 (Figure 2)

The most common site of ganglion cysts is the dorsum of the wrist
Figure 2. The most common sites of ganglion cysts include the dorsum of the wrist (70%) followed by the volar side of the wrist (20%), although they may occur anywhere on the body.

The size of the lesion is approximately 1 cm to 3 cm in diameter.4,7 The cyst typically fluctuates and often transilluminates.2,4,7Ganglion cysts are often asymptomatic but can be cosmetically disfiguring.2 (Figure 3)

Ganglion cysts are often asymptomatic but can be cosmetically disfiguring.
Figure 3. Ganglion cysts are often asymptomatic but can be cosmetically disfiguring.

Occasionally, there might be localized discomfort, pain, tenderness, paresthesia, or motor reduced range of motion of the affected joint.7,8 The condition can be complicated by compression neuropathies such as carpal tunnel syndrome, pudendal neuralgia, ulnar neuropathy, peroneal nerve palsy, posterior interosseous nerve palsy, as well as, though very rarely, contracture of the joint.9-14 In the pediatric age group, ganglion cysts usually resolve without intervention.15 Risk factors for recurrence include older age of onset, symptomatic mass, location around the wrist, and lesion requiring surgical excision.15

AUTHORS:
Alexander K.C. Leung, MD1,2, Benjamin Barankin, MD3, Joseph M. Lam, MD4, Alex H.C. Wong, MD,5 Kin Fon Leong, MD6

AFFILIATIONS:
1Clinical Professor of Pediatrics, the University of Calgary, Calgary, Alberta, Canada
2Pediatric Consultant, the Alberta Children’s Hospital, Calgary, Alberta, Canada
3Dermatologist, Medical Director and Founder, the Toronto Dermatology Centre, Toronto, Ontario, Canada
4Associate Clinical Professor of Pediatrics, Dermatology and Skin Sciences, the University of British Columbia, Vancouver, British Columbia, Canada
5 Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
6Pediatric Dermatologist, the Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia

CITATION:
Leung AKC, Barankin B, Lam JM, Leong KF. An Atlas of Lumps and Bumps, Part 46: Ganglion cysts. Consultant. 2024;64(12):eXX. doi: 10.25270/con.2024.12.000005.

CORRESPONDENCE:
Alexander K. C. Leung, MD, #200, 233 16th Ave NW, Calgary, AB T2M 0H5, Canada (aleung@ucalgary.ca)

EDITOR’S NOTE:
This article is part of a series describing and differentiating dermatologic lumps and bumps. To access previously published articles in the series, visit: https://www.consultant360.com/resource-center/atlas-lumps-and-bumps.

References

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  2. Gregush RE, Habusta SF. Ganglion cyst. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Aug 25 to 2021 Jan. PMID: 29262133.
  3. Rocchi V, Mubarak S. Ankle ganglion associated with tarsal coalition: A case report with a 5-year follow-up. JBJS Case Connect. 2020;10(3):e2000090. doi: 10.2106/JBJS.CC.20.00090.
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  6. Tang ZH, Rajaratnam V, Desai V. Incidence and anatomical distribution of hand tumours: a Singapore study. Singapore Med J. 2017;58(12):714-716. doi: 10.11622/smedj.2016147.
  7. Aizenberg DJ. Common complaints of the hands and feet. Med Clin North Am. 2021;105(1):187-197. doi: 10.1016/j.mcna.2020.08.016.
  8. Chen J, Liu Q, Xiong J, et al. Effect of fire needle for ganglion cysts: A protocol of systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020;99(41):e22602. doi: 10.1097/MD.0000000000022602.
  9. Goyal N, Luchetti TJ, Blank AT, Cohen MS. Atraumatic, progressive, and painful elbow contracture from a ganglion cyst. J Hand Surg Am. 2020:S0363-5023(20)30321-X. doi: 10.1016/j.jhsa.2020.06.005.
  10. Kim YJ, Kim DH. Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve. Yeungnam Univ J Med. 2020 Jul 21. doi: 10.12701/yujm.2020.00437.
  11. Omejec G, Podnar S. Differentiation of ulnar neuropathy at the wrist due to ganglion cyst from ulnar neuropathy at the elbow. Neurophysiol Clin. 2020;50(5):345-351. doi: 10.1016/j.neucli.2020.08.004.
  12. Papanastassiou ID, Tolis K, Savvidou O, Fandridis E, Papagelopoulos P, Spyridonos S. Ganglion cysts of the proximal tibiofibular joint: Low risk of recurrence after total cyst excision. Clin Orthop Relat Res. 2021;479(3):534-542. doi: 10.1097/CORR.0000000000001329.
  13. Purohit S, Prabhakar A, Raj A, Marathe N, Shah S. A rare case of posterior interosseous nerve palsy due to ganglion cyst arising from supinator muscle. J Clin Orthop Trauma. 2020;11(4):665-667. doi: 10.1016/j.jcot.2020.01.012.
  14. Singh S, Singh R, Tanwar M, Kaur K. Giant ganglion cyst of the proximal tibiofibular joint with peroneal nerve palsy: A case report. J Orthop Case Rep. 2020;10(2):5-8. doi: 10.13107/jocr.2020.v10.i02.1672.
  15. Mooney ML, Jacobs CA, Prusick VW, Riley SA. Pediatric ganglion cyst recurrence: Location isn't the only risk factor. J Pediatr Orthop. 2020;40(7):340-343. doi: 10.1097/BPO.0000000000001517.