GanglionEdit

A ganglion is a common, benign swelling that most often appears near joints or tendons. The prototypical example is the ganglion cyst, a soft lump that commonly forms on the dorsum or volar aspect of the wrist, though it can occur on the hand, foot, ankle, or knee. These lesions are not cancerous and are usually painless, though they can cause discomfort or functional limitation if they press on nearby nerves or restrict movement.

Histologically, a ganglion cyst is a sac-like structure lined by a thin layer of fibrous tissue and filled with a viscous, gelatinous fluid similar to synovial fluid. The cyst typically communicates with the nearby joint capsule or tendon sheath, but it is not a true joint or a true nerve tumor. The exact cause remains unsettled, but clinicians commonly associate ganglia with degenerative changes in nearby joints, repetitive microtrauma, or herniation of the synovial lining into a cystic pocket. The term itself derives from the Greek word for “knot” or “bunch.”

Diagnosis is usually clinical, based on the characteristic lump and its movement with the joint. Imaging is reserved for atypical presentations or when the diagnosis is unclear. Ultrasound ultrasound can confirm fluid-filled cysts and their connection to a joint or tendon, while MRI MRI provides detailed anatomy in complex cases. The differential diagnosis includes lipoma lipoma, epidermoid cyst epidermoid cyst, nerve sheath tumors nerve sheath tumor, and other soft-tissue masses such as giant cell tumor of the tendon sheath giant cell tumor of tendon sheath.

Common locations and presentations - Wrist: the most frequent site, often along the dorsum near the radiocarpal joint or the scapholunate area, but can appear on the volar side as well. See also the anatomical relationship to the carpal bones and the tendon sheath at the wrist. - Foot and ankle: small ganglia may arise near the tendons on the dorsal foot or around the ankle. - Fingers and knees: less common but recognized, sometimes presenting as a firm lump near a joint.

Management and outcomes Treatment is guided by symptoms, cosmetic concerns, and patient preferences. Many ganglion cysts are observed without intervention, as they may wax and wane or spontaneously resolve over time. When treatment is chosen, options include aspiration, corticosteroid injection, or surgical excision.

• Observation: For asymptomatic cysts or those causing only mild discomfort, watchful waiting is reasonable. If the cyst enlarges, becomes painful, or restricts function, more active management may be appropriate.
• Aspiration: Needle drainage of the cyst can provide relief, but recurrence is common, reported in a substantial fraction of cases. Aspiration can be performed with or without ultrasound guidance; success rates vary by location and technique. See also aspiration.
• Corticosteroid injection: In some cases, after aspiration, an injection of a steroid may reduce inflammation and the likelihood of recurrence, though results are variable.
• Surgical excision: Complete surgical removal of the cyst, its stalk, and the involved portion of the joint capsule or tendon sheath offers the lowest reported recurrence rate in many series, but it carries surgical risks such as infection, scarring, stiffness, and nerve or vessel injury. See also surgical excision and hand surgery for related care.

Recurrence and prognosis Recurrence after aspiration or steroid injection is relatively common, while complete surgical excision tends to lower the chance of a return. Many patients experience durable relief after appropriate treatment, and the prognosis for most ganglion cysts is favorable. The overall outlook is good, especially when management aligns with the patient’s functional goals and tolerances for risk and cost. See also recurrence.

Controversies and debates In clinical practice, the central debate centers on when and how aggressively to treat, balancing symptom burden, cosmetic concerns, functional impairment, recurrence risk, and cost. Proponents of a conservative approach emphasize treating the patient rather than the cyst: many patients do well with observation, and nonoperative measures avoid procedure-related risks and expenses. Those favoring more proactive treatment point to lower long-term recurrence with surgical excision and to faster restoration of function for active individuals. The choice often depends on location, symptoms, patient priorities, and access to expertise such as ultrasound-guided procedures or hand surgery. In this sense, the goal is to deliver practical, evidence-based care that minimizes unnecessary interventions while addressing meaningful impairment.

Etymology and related concepts The word ganglion reflects historical usage describing a knot or lump. In modern medicine, the term is used for several noncancerous lumps associated with joints or tendon sheaths. Related concepts include synovial tissue and the lining of joints and tendons, which can be involved in the formation of these cystic lesions. See also synovial fluid and joint capsule.

See also - ganglion cyst - joint capsule - tendon sheath - wrist - ultrasound - MRI - lipoma - epidermoid cyst - nerve sheath tumor - giant cell tumor of tendon sheath - surgical excision - hand surgery