Skin & Soft Tissue: Ganglion “Bible” Cyst

Basics

• A Cystic Swelling Filled with Synovial Fluid Over Joints
• Caused by Herniation of the Connective Tissue from Joint Capsules, Bursae & Tendon Sheaths
• 50% Resolve Spontaneously Over 1-2 Years
• “Bible Cyst” Comes from How Nuns Used to Slam Bibles on the Wrists of Children When Misbehaving – An Old Treatment Now Not Recommended was to Cause Closed Rupture of the Cyst with a Book/Bible
• Digital Mucinous Cyst – A Ganglion Cyst Over the Dorsal DIP Joint
  • Most Common in Elderly with Underlying Osteoarthritis

Presentation

• Mostly Asymptomatic
• Firm, Smooth & Rounded
• Mobile but Tethered in Place
• Transilluminates
• Can Cause Pain
• Can Cause Motor/Sensory Loss if Compressing Nerve
• Most Common Site: Dorsal Wrist (70%)
  • Second Most Common Site: Volar Wrist (20%)

Diagnosis

• Clinical (Based on History and Physical Exam)
• May Require US or MRI

Treatment

• Initial Treatment: Conservative Management
  • Asymptomatic: Observation
  • Mild Symptoms: Needle Aspiration (Over 50% will Recur)
• If Conservative Management Fails or Having Severe Symptoms: Excision & Ligation of Pedicle