Most Common Hand and Foot Mass | Fluid-Filled Lesion | High Spontaneous Resolution | Recurrence Common
Synovial Cyst Classification
Critical Must-Knows
- Ganglion cyst is the most common hand mass (60-70% of all hand masses)
- Spontaneous resolution occurs in 40-50% - observation is first-line for asymptomatic cysts
- Aspiration has 30-50% recurrence rate - excision recurrence 10-20%
- Key clinical features: Transilluminates (fluid-filled), fluctuant, wrist or finger location
- Baker's cyst is secondary to intra-articular knee pathology - treat underlying cause first
Clinical Pearls
- "Ganglion fluid is thick, clear, mucinous (mucopolysaccharide-rich) - NOT synovial fluid
- "Dorsal wrist ganglion arises from scapholunate ligament (60-70% of wrist ganglia)
- "Occult dorsal wrist ganglion can cause dorsal wrist pain without visible mass
- "Bible cyst = old name for ganglion (historically hit with Bible to rupture)
Clinical Imaging
Imaging Gallery
Critical Synovial Cyst Exam Points
Most Common Hand Mass
Ganglion cyst accounts for 60-70% of all hand masses. Dorsal wrist most common location (dorsal scapholunate ligament origin). Volar wrist second most common (volar radiocarpal joint or scaphotrapezial joint).
Clinical Diagnosis
Transillumination is key clinical test. Ganglion transilluminates (fluid-filled) whereas solid masses (GCTTS, lipoma, neuroma) do not. Fluctuant, mobile, painless mass near joint or tendon sheath.
Natural History
40-50% resolve spontaneously within 1-2 years. Observation is first-line for asymptomatic ganglia. Symptomatic (pain, mass effect, cosmetic) warrant intervention.
Treatment Strategy
Stepwise approach: Observation → Aspiration → Excision. Aspiration has 30-50% recurrence. Excision has 10-20% recurrence. Complete excision with cyst stalk and capsule critical to minimize recurrence.
Quick Decision Guide - Synovial Cyst Management
| Presentation | Type | Treatment | Key Pearl |
|---|---|---|---|
| Asymptomatic dorsal wrist mass, incidental finding | Dorsal wrist ganglion | Observation (40-50% resolve spontaneously) | Reassure patient about benign nature |
| Painful wrist mass, limits function, patient requests removal | Symptomatic ganglion | Aspiration trial, then excision if recurs | Excise with stalk and capsule to reduce recurrence |
| Posterior knee swelling, associated with knee OA or meniscal tear | Baker's (popliteal) cyst | Treat underlying knee pathology first | Cyst often resolves when intra-articular pathology treated |
| Back pain with radiculopathy, facet joint cyst on MRI compresses nerve | Spinal synovial cyst | Surgical decompression if symptomatic | Laminectomy and cyst excision for neurological symptoms |
GANGLIONGanglion Cyst Features
| G | Gelatinous fluid Thick, clear, mucinous contents (mucopolysaccharides) |
| A | Arises from joint capsule Or tendon sheath - connected by stalk |
| N | No true epithelial lining Pseudocyst (fibrous wall, no epithelium) |
| G | Grows slowly Painless mass over months to years |
| L | Luminescent (transilluminates) Pathognomonic clinical sign |
| I | Incompletely understood etiology Theories: trauma, joint degeneration, mucinous degeneration |
| O | Often resolves spontaneously 40-50% disappear without treatment |
| N | Near wrist or finger joints Dorsal wrist most common (60-70%) |
| G | Gelatinous fluid Thick, clear, mucinous contents (mucopolysaccharides) | G | Grows slowly Painless mass over months to years | O | Often resolves spontaneously 40-50% disappear without treatment |
| A | Arises from joint capsule Or tendon sheath - connected by stalk | L | Luminescent (transilluminates) Pathognomonic clinical sign | N | Near wrist or finger joints Dorsal wrist most common (60-70%) |
| N | No true epithelial lining Pseudocyst (fibrous wall, no epithelium) | I | Incompletely understood etiology Theories: trauma, joint degeneration, mucinous degeneration |
Hook:GANGLION - the gelatinous mass that GLOWs with transillumination!
WRISTGanglion Cyst Locations
| W | Wrist dorsal (most common) 60-70% - arises from scapholunate ligament |
| R | Radiocarpal volar 20-30% - volar wrist at radiocarpal or scaphotrapezial joint |
| I | Interphalangeal (mucous cyst) Distal IP joint - often with OA (Heberden's node) |
| S | Scapholunate ligament origin Dorsal ganglia arise from SL ligament |
| T | Tendon sheath (flexor) Volar digit - retinacular cyst (seed ganglion) |
| W | Wrist dorsal (most common) 60-70% - arises from scapholunate ligament | S | Scapholunate ligament origin Dorsal ganglia arise from SL ligament |
| R | Radiocarpal volar 20-30% - volar wrist at radiocarpal or scaphotrapezial joint | T | Tendon sheath (flexor) Volar digit - retinacular cyst (seed ganglion) |
| I | Interphalangeal (mucous cyst) Distal IP joint - often with OA (Heberden's node) |
Hook:WRIST - where ganglia love to form!
KNEEBaker's Cyst Associated Pathology
| K | Knee osteoarthritis Most common cause - degenerative joint |
| N | Nonspecific synovitis Inflammatory arthritis (RA) |
| E | Effusion (chronic) Any cause of chronic knee effusion |
| E | Erosive meniscal tear Meniscal pathology with joint effusion |
| K | Knee osteoarthritis Most common cause - degenerative joint | E | Effusion (chronic) Any cause of chronic knee effusion |
| N | Nonspecific synovitis Inflammatory arthritis (RA) | E | Erosive meniscal tear Meniscal pathology with joint effusion |
Hook:KNEE pathology drives Baker's cyst - treat the knee, not just the cyst!
Overview and Epidemiology
Why Synovial Cysts Matter Clinically
Synovial cysts are the most common soft tissue masses of the hand and wrist, accounting for 60-70% of all hand masses. Ganglion cysts are benign fluid-filled lesions arising from joint capsule or tendon sheath, filled with thick mucinous fluid. Despite being benign and having high spontaneous resolution rates (40-50%), they cause patient anxiety and functional impairment when symptomatic. Understanding natural history and treatment options (observation, aspiration, excision) is critical for appropriate management. Popliteal (Baker's) cysts and spinal synovial cysts represent different anatomical locations with distinct clinical significance.
Demographics (Ganglion)
- Age: Peak incidence 20-50 years (young to middle-aged adults)
- Gender: Female predominance 3:1
- Location: Hand/wrist 60-70%, foot/ankle 10-20%, knee 5-10%
- Laterality: No dominant hand preference
Clinical Impact
- Most common hand mass: 60-70% of all hand masses
- Spontaneous resolution: 40-50% resolve without treatment
- Recurrence: 30-50% after aspiration, 10-20% after excision
- Functional impairment: Pain, mass effect, cosmetic concern
The classic patient is a young to middle-aged woman with a painless fluctuant mass on the dorsal wrist that transilluminates.
Pathophysiology and Etiology
Ganglion is a Pseudocyst - Not a True Cyst
Ganglion cysts do NOT have an epithelial lining (hence "pseudocyst"). The wall is composed of compressed fibrous tissue. The cyst connects to the joint capsule or tendon sheath via a stalk or pedicle. Contents are thick, clear, mucinous fluid (high concentration of mucopolysaccharides, hyaluronic acid, glucosamine) - NOT synovial fluid.
| Feature | Mechanism | Clinical Consequence |
|---|---|---|
| Mucin production | Degeneration of connective tissue produces mucopolysaccharides | Thick gelatinous fluid accumulates in cyst cavity |
| One-way valve | Stalk acts as one-way valve allowing fluid in but not out | Cyst enlarges with joint motion, does not drain back to joint |
| Joint connection | Cyst communicates with joint via stalk/pedicle | Recurrence common if stalk not excised |
| Spontaneous rupture | Trauma or pressure can rupture cyst into soft tissues | Sudden disappearance of mass (but often recurs) |
Etiology (Theories)
- Trauma theory: Repetitive microtrauma causes mucinous degeneration
- Joint degeneration: Osteoarthritis or ligament laxity
- Herniation theory: Synovium herniates through joint capsule
- Unknown: Exact etiology remains incompletely understood
Contents Analysis
- Thick, clear, gelatinous fluid: High viscosity
- Mucopolysaccharides: Hyaluronic acid, glucosamine
- NOT synovial fluid: Different composition (higher mucin)
- Sterile: No organisms (unless infected after aspiration)
The key concept is that ganglion cysts are mucinous degenerative lesions, not inflammatory or neoplastic processes.
Classification and Anatomical Variants
Wrist Ganglion Cysts (60-70% of all ganglia)
Dorsal Wrist Ganglion (Most Common):
- Arises from scapholunate (SL) ligament
- Presents as firm mass over dorsal wrist
- May be occult (no visible mass, but dorsal wrist pain)
- Treatment: Observation vs aspiration vs excision with SL ligament debridement
Volar Wrist Ganglion (Second Most Common):
- Arises from radiocarpal joint or scaphotrapezial joint
- Near radial artery (danger during aspiration/excision)
- May cause radial artery compression or median nerve compression
- Treatment: Same as dorsal, but higher risk (radial artery proximity)
Occult Ganglion:
- No visible or palpable mass
- Dorsal wrist pain, tenderness over scapholunate ligament
- MRI shows small cyst within SL ligament
- Treatment: Arthroscopic vs open debridement of SL ligament
Wrist ganglia are the prototypical ganglion cysts.
Location Dictates Clinical Significance
The critical exam point: Ganglion cysts at different anatomical locations have distinct clinical significance. Wrist ganglia are primarily cosmetic/functional concerns. Baker's cysts reflect intra-articular knee pathology. Spinal synovial cysts cause radiculopathy requiring decompression. Same pathological process (synovial-derived cyst), different management based on location.
Clinical Presentation and Assessment
History (Ganglion)
- Mass: Painless fluctuant swelling (months to years)
- Location: Dorsal or volar wrist, finger (DIP joint)
- Symptoms: Usually asymptomatic, may have pain if large
- Variation: Size fluctuates (worse with activity)
- Trauma: Usually no trauma (helps rule out hematoma)
Examination (Ganglion)
- Inspection: Visible fluctuant mass
- Palpation: Soft to firm, mobile, non-tender
- Transillumination: POSITIVE (fluid-filled) - pathognomonic
- Range of motion: Usually normal (unless large cyst)
- Neurovascular: Intact (volar ganglia may compress nerve/artery)
Transillumination - Pathognomonic Clinical Sign
Transillumination test: Shine penlight through mass in dark room. Ganglion cyst transilluminates (light passes through fluid). Solid masses (GCTTS, lipoma, neuroma) do NOT transilluminate. This simple bedside test distinguishes cystic from solid masses with high accuracy.
Popliteal (Baker's) Cyst Presentation:
- Swelling: Popliteal fossa fullness or mass
- Pain: Posterior knee discomfort
- Associated symptoms: Knee pain, mechanical symptoms (meniscal tear, OA)
- Ruptured cyst: Acute calf pain and swelling (mimics DVT - exclude with ultrasound)
Spinal Synovial Cyst Presentation:
- Back pain: Chronic lumbar back pain
- Radiculopathy: Leg pain, numbness, weakness (dermatomal distribution)
- Neurogenic claudication: Leg symptoms with walking (if stenosis)
- Examination: Positive straight leg raise, dermatomal sensory loss, weakness
The key clinical feature of ganglion cysts is transillumination.
Imaging and Diagnosis
Diagnostic Imaging Protocol (Ganglion)
Most ganglia diagnosed clinically: Transillumination + fluctuant mass = ganglion cyst.
No imaging needed for typical presentation.
Appearance: Anechoic (fluid-filled) cyst with posterior acoustic enhancement.
Advantages: Cheap, quick, can assess relationship to vessels (volar ganglia).
Sensitivity: Over 90% for ganglion cyst diagnosis.
MRI features: High signal on T2 (fluid), low signal on T1, well-defined margins.
Occult ganglion: Small cyst within scapholunate ligament causing dorsal wrist pain.
Surgical planning: Define stalk/pedicle for complete excision.
Aspirate appearance: Thick, clear, gelatinous fluid (pathognomonic).
Send for: Cell count, culture (if infection suspected), cytology (if malignancy concern).
Therapeutic: 30-50% cure rate with aspiration alone.
Imaging is Usually NOT Needed for Ganglion Cysts
Q: What imaging is required to diagnose a ganglion cyst? A: None in most cases - ganglion cysts are diagnosed clinically based on transillumination and fluctuant mass. Ultrasound can confirm if diagnosis uncertain. MRI reserved for occult ganglia (dorsal wrist pain without palpable mass) or surgical planning. Plain radiographs are normal (rule out bone lesion).
Differential Diagnosis
Ganglion Cyst Differential Diagnosis
| Condition | Key Distinguishing Features | Imaging/Clinical Differences |
|---|---|---|
| Giant cell tumor of tendon sheath (GCTTS) | Solid mass, does NOT transilluminate, firm/rubbery | MRI low signal T1/T2 (hemosiderin), solid on US |
| Lipoma | Soft, mobile, does not transilluminate, painless | MRI high signal T1 (fat), fat on US |
| Neuroma (Morton's, digital) | Painful (Tinel's sign), does not transilluminate, nerve distribution | MRI low to intermediate signal, solid |
| Synovial sarcoma | MALIGNANT, painful, rapid growth, young adults | Heterogeneous MRI signal, invasion, calcification |
| Abscess | Erythema, warmth, fever, fluctuant, history of trauma/infection | US/MRI shows fluid collection with rim enhancement |
The critical distinction is cystic (ganglion, abscess) versus solid (GCTTS, lipoma, neuroma) - transillumination test differentiates.
Management and Treatment
Observation for Asymptomatic Ganglia
Indications: Asymptomatic or minimally symptomatic ganglion cyst.
Observation Protocol
Reassure: Benign, not cancer, 40-50% resolve spontaneously within 1-2 years.
Natural history: May fluctuate in size, may disappear and recur.
Avoid: Repetitive wrist flexion/extension (may enlarge cyst).
Splint: Can use wrist splint if symptomatic (reduces cyst size in some).
Follow-up: Reassess at 3-6 months.
Indications for intervention: Persistent symptoms, growth, patient preference.
Observation is appropriate first-line for most asymptomatic ganglion cysts given high spontaneous resolution rate.
Complete Excision with Stalk - Key to Prevent Recurrence
The single most important technical factor to prevent ganglion recurrence is complete excision of cyst with stalk and portion of joint capsule. The stalk connects the cyst to the joint - if not excised, fluid can re-accumulate from the joint. For dorsal wrist ganglia, debridement of scapholunate ligament attachment is critical. Recurrence: 10-20% after complete excision vs 30-50% after aspiration.
Complications of Treatment
| Complication | Incidence/Risk Factors | Prevention/Management |
|---|---|---|
| Recurrence (most common) | 10-20% after excision, 30-50% after aspiration | Complete excision with stalk and capsule |
| Neurovascular injury | Volar ganglia near radial artery and median nerve | Identify and protect neurovascular structures |
| Stiffness | Prolonged immobilization, scar adhesions | Early range of motion (1-2 weeks) |
| Infection | Under 1% risk (aspiration or excision) | Sterile technique, antibiotics if indicated |
| Scar (cosmetic) | All surgical excisions leave scar | Transverse incision in skin crease |
Volar Ganglion - Radial Artery is Adjacent
Volar wrist ganglia are near the radial artery (and sometimes median nerve). Aspiration or excision carries risk of arterial injury (bleeding, pseudoaneurysm, thrombosis). Always identify radial artery pulsation, use ultrasound guidance for aspiration if concerned, and protect radial artery during surgical excision. Allen test pre-operatively to confirm ulnar collateral circulation.
The major complication is recurrence, which is why complete excision with stalk is critical.
Postoperative Care and Rehabilitation
Postoperative Rehabilitation Protocol (Ganglion Excision)
- Splint in wrist neutral position
- Elevation to reduce swelling
- Pain control (oral analgesics)
- Keep dressing clean and dry
- Remove splint at 1-2 weeks
- Early active ROM to prevent stiffness
- Scar massage once sutures removed (10-14 days)
- Light activities of daily living
- Progressive strengthening exercises
- Return to unrestricted activities at 4-6 weeks
- Scar continues to mature (6-12 months)
- Most recurrences occur within 1 year
- If recurrence, consider re-excision vs observation
- Recurrence rate: 10-20%
Early range of motion is critical to prevent wrist stiffness after ganglion excision.
Outcomes and Prognosis
| Treatment | Recurrence Rate | Advantages/Disadvantages |
|---|---|---|
| Observation | 40-50% resolve spontaneously | Advantages: No risk. Disadvantages: May not resolve, time |
| Aspiration | 30-50% recurrence | Advantages: Office-based, quick. Disadvantages: High recurrence |
| Excision | 10-20% recurrence | Advantages: Lowest recurrence. Disadvantages: Surgery, scar, stiffness risk |
Stepwise Approach - Observation → Aspiration → Excision
Management algorithm: Start conservative (observation for asymptomatic, aspiration for symptomatic who want to avoid surgery), progress to excision if conservative fails or patient prefers definitive treatment. Recurrence rates: observation 40-50% resolve (so 50-60% persist), aspiration 30-50% recur, excision 10-20% recur. Patient satisfaction highest with excision due to low recurrence and definitive treatment.
Overall outcomes are excellent with high patient satisfaction regardless of treatment chosen.
Evidence Base and Key Studies
Natural History of Untreated Dorsal Wrist Ganglia (Landmark Prospective Cohort)
- Prospective cohort of 283 patients (236 responders, mean 70-month follow-up) comparing excision, aspiration and no treatment
- Spontaneous resolution of untreated ganglia: 58% (23/55)
- Recurrence: 58% after aspiration (45/78) and 39% after excision (40/103)
- Symptom resolution similar across all three groups (p greater than 0.3)
- Patient satisfaction highest after surgical excision, even if the ganglion recurred
Ganglions of the Hand and Wrist (Foundational Review)
- Narrative review establishing the modern observation-aspiration-excision treatment paradigm
- Recurrence after aspiration greater than 50% at most sites, but under 30% for flexor tendon sheath cysts
- Surgical excision recurrence only ~5% IF the cyst stalk and a small cuff of joint capsule are removed
- Observation acceptable in most cases; aggressive treatment for pain, functional limitation, nerve compression or impending mucous-cyst ulceration
Exam Viva Scenarios
Use these scenarios to practise clinical reasoning and management decisions
Scenario 1: Dorsal Wrist Mass in Young Woman
"A 32-year-old woman presents with a 6-month history of a painless mass on the dorsal wrist. On examination, you find a 2cm fluctuant, mobile, non-tender mass over the dorsal wrist that transilluminates. What is your diagnosis and management?"
Scenario 2: Baker's Cyst in Patient with Knee OA
"A 58-year-old man with known knee osteoarthritis presents with new posterior knee swelling and fullness. Ultrasound confirms a 4cm popliteal (Baker's) cyst. He requests treatment for the cyst. How do you manage?"
Scenario 3: Occult Dorsal Wrist Ganglion
"A 28-year-old gymnast presents with 12 months of dorsal wrist pain. No visible or palpable mass. Tenderness over scapholunate ligament area. Plain radiographs normal. How do you proceed?"
MCQ Practice Points
Epidemiology Question
Q: What percentage of hand masses are ganglion cysts? A: 60-70% - Ganglion cyst is the most common hand mass. Dorsal wrist location accounts for 60-70% of all ganglia (arise from scapholunate ligament). Second most common hand tumor overall is giant cell tumor of tendon sheath (GCTTS) at 10%.
Clinical Diagnosis Question
Q: What is the pathognomonic clinical test for ganglion cyst? A: Transillumination test - Shine penlight through mass in dark room. Ganglion cyst transilluminates (light passes through fluid). Solid masses (GCTTS, lipoma, neuroma) do NOT transilluminate. This bedside test distinguishes cystic from solid masses with high accuracy.
Natural History Question
Q: What percentage of ganglion cysts resolve spontaneously? A: 40-50% within 1-2 years. This high spontaneous resolution rate justifies observation as first-line treatment for asymptomatic ganglia. Patients should be counseled about benign nature and expectant management.
Treatment Question
Q: What is the recurrence rate after ganglion cyst aspiration vs excision? A: Aspiration: 30-50% recurrence. Excision: 10-20% recurrence. Complete excision with stalk and portion of joint capsule minimizes recurrence. Aspiration has higher recurrence because stalk remains intact, allowing fluid re-accumulation from joint.
Baker's Cyst Question
Q: What is the key principle in managing Baker's (popliteal) cyst? A: Treat the underlying knee pathology, not the cyst. Baker's cyst is a secondary phenomenon caused by increased intra-articular pressure transmitted through a one-way valve from knee effusion (OA, meniscal tear, RA). In a meta-analysis of surgical series, success was highest (96.7%) when the cyst-joint communication was enlarged and intra-articular pathology addressed, rather than the cyst simply closed/excised. Treating the joint is what makes resolution durable.
Guidelines, Registries & Global Practice
Global Epidemiology
- Most common hand/wrist mass worldwide (around 60-70% of hand soft-tissue masses)
- Demographics: peak 20-50 years, female predominance roughly 3:1
- Distribution: dorsal wrist most common, then volar wrist, then DIP mucous cysts
- Popliteal cysts rise with age and OA prevalence; common incidental MRI finding globally
Registry & Evidence Notes
- No dedicated implant registry (no implant used) - evidence is from cohorts and a small number of RCTs
- Best comparative data: Dias 2007 cohort (natural history) and Kang 2008 RCT (arthroscopic vs open)
- Popliteal-cyst surgical evidence pooled only in retrospective meta-analysis (Zhou 2016)
- Spinal synovial cyst evidence is observational (e.g. Page 2021): decompression +/- fusion
Side-by-Side Society / Body Guidance
| Body | Position on Ganglion / Synovial Cyst | Practical Emphasis |
|---|---|---|
| ASSH / IFSSH (hand surgery societies) | Reassurance and observation first-line for asymptomatic ganglia; clinical diagnosis, imaging only if atypical | Counsel on high spontaneous-resolution and recurrence rates before any procedure |
| AAOS / orthopaedic consensus (general) | Stepwise observation to aspiration to excision; excision reserved for symptomatic or failed conservative care | Complete stalk and capsular-cuff excision to minimise recurrence |
| BOA / UK hand units | Many ganglia managed in primary/community care; surgery for pain, function or nerve compression | Watchful waiting actively offered; avoid unnecessary MRI |
| AANS/CNS & spine bodies (spinal synovial cyst) | Decompression with cystectomy effective; add fusion if instability/spondylolisthesis | No single mandated algorithm - decision individualised to facet/instability findings |
High-Resource Settings
- Ready access to ultrasound and MRI for atypical or occult lesions
- Arthroscopic excision available where expertise exists (equivalent recurrence to open)
- Hand therapy for structured post-operative ROM and scar management
Limited-Resource Settings
- Clinical diagnosis and transillumination remain the mainstay - imaging often unnecessary
- Reassurance/observation is a high-value, zero-cost first-line strategy
- Open excision with complete stalk removal is the practical definitive option when surgery is indicated
Universal Consent and Medicolegal Points
Document regardless of healthcare system:
- Natural history: high spontaneous-resolution rate - observation is a valid first-line choice that MUST be offered
- Recurrence risk: substantial after aspiration, lower but non-zero after complete excision
- Neurovascular injury: volar ganglia lie adjacent to the radial artery and median nerve (Allen test, protect the artery)
- Stiffness: prevent with early ROM; scar: visible hand scar is a recognised cosmetic trade-off
Recurring litigation themes worldwide: proceeding to surgery without offering observation, radial-artery injury during volar excision, and failure to counsel recurrence pre-operatively.
Synovial/ganglion cysts are common and benign across all regions; the globally consistent message is reassurance first, clinical diagnosis, and complete stalk excision only when intervention is genuinely indicated.
SYNOVIAL CYSTS (GANGLION AND JOINT CYSTS)
Clinical summary
Key Features
- •Most common hand mass (60-70% of all hand masses)
- •Fluid-filled pseudocyst (no epithelial lining, fibrous wall)
- •Contains thick, clear, mucinous fluid (mucopolysaccharides)
- •Transilluminates (pathognomonic clinical sign)
Locations
- •Dorsal wrist (60-70% of ganglia) - arises from scapholunate ligament
- •Volar wrist (20-30%) - radiocarpal or scaphotrapezial joint
- •DIP joint (mucous cyst) - associated with OA (Heberden's node)
- •Popliteal (Baker's cyst) - posterior knee, secondary to knee pathology
Natural History
- •40-50% resolve spontaneously within 1-2 years
- •Observation first-line for asymptomatic ganglia
- •Size fluctuates (worse with activity)
- •Recurrence: 30-50% after aspiration, 10-20% after excision
Treatment Algorithm
- •Asymptomatic: Observation (reassure benign, spontaneous resolution)
- •Symptomatic: Aspiration (30-50% recurrence) or Excision (10-20% recurrence)
- •Excision technique: Complete excision with stalk and capsule (minimize recurrence)
- •Baker's cyst: Treat underlying knee pathology, not the cyst
Surgical Pearls
- •Transverse incision in skin crease for cosmesis
- •Protect radial artery and median nerve (volar ganglia)
- •Excise with stalk traced to joint capsule origin
- •Dorsal ganglia: Debride scapholunate ligament attachment