With up to 60%, wrist ganglia are the most common soft tissue tumors of the wrist. Their average size is 1-2 cm, they can occur uni- and multilocular. For the male gender, the overall incidence is 25/100,000, for the female 43/100,000. Women are affected approximately 2- to 3-times more frequently than men [1-5]. 70% of ganglia occur between the ages of 20-40 years, 10% between 10-20 years, and 1-2% below the 10th year of life. In adults, the ganglion is found dorsally in 80% of cases, volarly in 20% of cases. In children under the 10th year of life, the volar localization is significantly more common at 60-77% [5, 6].
The ganglion usually originates from the radiocarpal joint, occasionally also from the midcarpal joint and here particularly from the trapezionavicular joint. A mucoid degeneration of the joint capsule with simultaneous capsule weakening is causative [2, 4]. The clear, highly viscous ganglion content exhibits a high concentration of hyaluronic acid and other mucopolysaccharides [2].
Spontaneous remissions occur and are reported at 10-63 % [4, 7].
The conservative treatment includes watchful waiting as well as puncture and aspiration of the ganglion content, possibly multiple times. The instillation of a corticosteroid, ethanol, or hyaluronidase is also possible [3, 4]. The combination of aspiration and electrocauterization is described, as well as treatment with an orthosis [3-5]. For aspiration alone, the recurrence rate is over 50%, but can be reduced to 13% by instillation of a corticosteroid [8].
The indication for surgical treatment arises in cases of persistent symptoms, recurrences, and failed conservative treatment [9-11]. The resection of the ganglion can be performed both open surgically and arthroscopically, and the ganglion stalk should be removed as well [4, 11].
A meta-analysis showed that open ganglion resection reduces the recurrence rate by 76% compared to puncture alone [3]. For open surgical resection, the recurrence rate is 4-40%, for the arthroscopic technique 0-11% [4, 11-13]. Risk factors for recurrence include handedness, dominant arm, female gender, and age < 24 years [11, 13].