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.