Ganglion M67.40

Spherical, bulging pseudocyst protruding from the skin with a gelatinous content. In most cases no connection to the joint space can be detected.

Joint proximity, back of the hand, back of the foot, plantar, knee joint; along tendons.

Uni- or multilocular, 1.5-4.0 cm in size, skin-coloured, tightly elastic, hemispherical, hardly movable on the base, non-irritating, painless cystic elevations. A feeling of pressure or slight pain symptoms are rather rare. From a certain size and plumpness the cysts burst after banal injuries. A glassy, gelatinous substance is discharged. After a certain amount of time, however, the cyst fills up again. A characteristic feature of a cyst that persists for a long time is a flat nail dystrophy that is limited to the cyst area.

Numerous cavities, mostly in folds (caused by collapse of the pseudocyst), which have no endothelial lining. The stored mucin can be stained with Alzina blue. The wall consists of coarse hyalinized connective tissue. The connective tissue surrounding the cyst is extremely loosened. No inflammatory symptoms.

Excision

Synovial cysts play a major role in other specialties (orthopedics). An example of this is the "Baker cyst". The clinical counterpart of a ganglion on the finger is the mucoid dorsal cyst.

1. Burke FD et al (2003) Primary care referral protocol for wrist ganglia.postgrade Med J 79: 329-331
2. Slides J, Book K (2003) Palmar wrist ganglion: does intervention improve outcome? A prospective study of the natural history and patient-reported treatment outcomes. J Hand Surgery 28: 172-176
3. Ehara S (2003) Communication of the ganglion with the joint and the tendon sheath. AJR Am J Roentgenol 180: 541-542
4. McAllister DR et al (2003) Plantar ganglion cyst associated with stress fracture of the third metatarsal. At J Orthop 32: 35-37