Removal of Cysts, Tumors and Skin Lesions
A cyst is an abnormal, closed sac-like structure within a tissue that contains a liquid, gaseous, or semisolid substance. A cyst can occur anywhere in the body and can vary in size. Cysts, tumors and skin lesions of the hand and upper extremity are common, often presenting as lumps and bumps.
Clinically, one should determine if the tumor is bony, cystic, or soft tissue in origin. The site, size, shape, consistency and margins of the lesion should be determined, including the condition of the overlying skin, its mobility, whether it is stuck to the underlying tissues, or closely related to important structures such as tendons and nerves. In view of this, a detailed clinical examination should be conducted by a qualified hand surgeon. Advice on the necessity of surgery can also be given. Sometimes, wrist ganglion cysts go away with no treatment, most of the time they linger around or even grow larger. Some cysts form a type of one-way valve such that fluid enters the cyst easily, but cannot escape. When the ganglion cyst becomes large enough, it will begin to put pressure on surrounding structures. This pressure can cause painful symptoms, and is usually the reason these ganglion cysts are removed.
The following shows the various forms of ganglion cyst.
Ganglion associated with osteoarthritis of the finger joint
Digital ganglion arising from the tendon sheath
Dorsal wrist ganglion
Volar wrist ganglion
Figure A: Ganglion Cyst
Figure B: Removal of a recurrent dorsal wrist ganglion cyst
Sometimes a lump in the wrist may not be a ganglion cyst. From clinical examination if we suspect it to be more than a ganglion cyst, an MRI can assist in helping us make the diagnosis.
Figure C: Patient presents with wrist lump and MRI showed this to be a nerve tumour
Figure D: Median Nerve Tumour (left) and Tumour excised with magnification (right)
