Ganglion cysts of the wrist: pathophysiology, clinical picture, and management

This article reviews what is known about ganglion cyst formation, natural history (50% of cysts will spontaneously resolve), diagnosis, and management of this common malady. Although the exact mechanism of cyst formation is unknown, most current theories hold that extraarticular mucin droplets'' coalesce to form the main body of the tumor. Only subsequently are the cyst wall'' and pedicle (connecting the cyst to a nearby synovial joint) formed. Treatment options include watchful waiting, nonoperative aspiration/injection, and surgical removal. Although treatment is often unnecessary, many patients seeking consultation desire some form of definitive treatment. Cyst aspiration/injection is fraught with a high incidence of recurrence. Surgery generally results in lower rates of recurrence, but a higher incidence of complications. All current treatment options are suboptimal.