ganglion cysts

medical treatment

- aysmptomatic= observation - aspiration: 20% recurrence - excision< 10% recurrence educate client cyst may reoccur

operative interventions

- bulky dressing x 5 days - controlled progression of activity - edema control: elevation, retrograde massage, compression, muscle pumping - progressive ROM exercise: tendon gliding and blocking exercises - immobilize skin grafts or flaps x2 weeks - scar tissue management

associated conditions

- deQuervains tenosynovitis - volar flexor tenosynovitis (trigger finger) - pyogenic flexor tenosynovitis - lipoma or other soft tissue tumors - dupuytren's disease (contracture)

dorsal wrist ganglion

- dorsal presentation more common: 60-70% - usually from scapholunate joint: btwn EPL and EDC

mucous cyst

- ganglion cyst from arthritic joint: most common inDIP - palpable mass near a joint, +/- tenderness - close association with osteoarthritis

carpal boss

- osteoarthritic spur over CMC of 2/3 digits - where ECRL/ECRB insert - firm, non mobile, tender, can be observed w/ wrist flexion not a cyst

volar retinacular cyst

- palpable and symptomatic - involves flexor tendon sheath - near MCP or PIP joints

intraosseus ganglion

- rare - involvement of scaphoid or lunate - wrist pain w/o clear etiology of visible cyst in the bone

complications

- recurrence of ganglion cyst - neuroma develops: if wrap around nerve - stiffness of wrist and hand

conclusions

- strive for improved use of involved hand - orthotic device should allow function - educate on flare ups and how to manage them - begin scar management as soon as sutures are removed - ganglion cysts can recur performance of bilateral activities

non operative intervention

- therapy is aimed in the normal use of the hand - symptom management: orthotic devices PRN -gentle home exercise programs - instruction on heat/cold modalities - flares: rest, orthotic devices, activity modifications immobilization, rest, reduce offending factors, pain, promote function - isometric exercise, instruction on orthotic device use

extensor reticular cyst

- uncommon - involves 1st extensor compartment: abductor pollicis longs and extensor policies braves tendons, associated with deQuervains tenosynovitis

assessment

- wrist and digital motion - grip and pinch strength - visual analog pain scale - sensory screening and assessment - ADL measure: Disabiliities of arm shoulder and hand (DASH) MMT: ECRL: base of 2nd finger ECRB: base of 3rd finger intrinsics: move from intrinsic plus into claw hand

ganglion cyst

-synovial fluid filled cyst arising from a joint, ligament, or tendon - palpable, mobile mass - most common mass seen in wrist - due to chronic irritation and connective tissue degeneration repetitive use of body part - shine a light through and see it is liquid filled

volar wrist ganglion

2nd most common type: 15-20% - scapholunate ligament: radial side over FCR - perform allens vascular test

digital stenosing tenosynovitis

another name for trigger finger

occult ganglion

unexplained wrist pain and disproportionate tenderness - common source of pressure on posterior interosseous nerve - may be detected by placing wrist in marked position symptom management: manage pain, modify painful activities if possible

device for ganglion cysts

volar wrist extension orthosis