Ganglion
cysts
These are the most common swellings in the hand. Patients present with
concern about the lump and occasionally with pain. The swelling is smooth, well
defined, fluctuant and transilluminable. A few resolve with aspiration or
compression (‘hitting with the family bible’). Surgery should be meticulous
otherwise recurrence is likely. Ganglia around the wrist should be traced down
to their source, usually the scapholunate ligament and sometimes the
scapho-trapezio-trapezioid joint. Histology shows a compressed collagen sheath
filled with a mucoid substance.