Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in various locations, but most frequently develop on the back of the wrist. These fluid-filled cysts can quickly appear, disappear, and change size. Many ganglion cysts do not require treatment. However, if the cyst is painful, interferes with function, or has an unacceptable appearance, there are several treatment options available

Tumors of the hand are found to be benign 95% of the time in the course of excluding a cutaneous malignancy. Representing about 60% of these benign tumors is the ganglion cyst. Although no definitive etiology has been established, the theory that the ganglion is the degeneration of the mucoid connective tissue, specifically collagen, has dominated since 1893, when Ledderhose described it as such.

The problems that ganglion cysts present can be varied and are due to their location. Most often, the cyst will present at the dorsal wrist, accounting for 60-70% of all hand and wrist ganglia , and arise from the scapholunate joint. A ganglion cyst can also arise from the radioscaphoid or scaphotrapezial joint volarly.These locations can cause joint instability, weakness, and limitation of motion.

Compression of the median nerve can occur when a volar radial ganglion arises within the carpal canal.The ulnar nerve may also be compressed within the tunnel of Guyon when the ganglion presents on the ulnar side of the wrist.The patient can experience paresthesias and pain from a ganglion cyst, and in such cases, surgical treatment should be considered, to provide a favorable outcome with few complications.

Multiple nonsurgical modalities have been used over the years for ganglion cyst, including simple aspiration. Surgery (open or arthroscopic) often becomes necessary, and current evidence suggests that arthroscopic ganglion excision is a practical and successful means of dorsal ganglion cyst removal.

Pharmacologic agents are under constant investigation in the medical arena. Potential advances in sclerosing agents specific to the treatment of ganglion cysts may lead to a definitive medical treatment of ganglions, which would avoid surgery.

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