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Ganglia and nodules

INTRODUCTION

Soft tissue masses are usually benign and of little clinical consequence. However, benign lesions such as ganglia and nodules may interfere with joint function and therefore require treatment. The differential diagnosis of nodular soft tissue masses is extensive and includes a number of systemic diseases and solid tumors (table 1A-B).

GANGLIA

A ganglion is a cystic swelling overlying a joint or tendon sheath. Ganglia are thought to arise due to herniation of synovial tissue from a joint capsule or tendon sheath. They represent myxoid degeneration and may be of congenital origin. The role, if any, of repetitive movement in causation is uncertain, although it may induce enlargement of the lesion and provoke symptoms.

Common locations for ganglia include the wrist and tissue adjacent to finger joints (picture 1). They also occur over the dorsum of the foot, and less often may arise in the knee, shoulder or other intra-articular, extra-articular soft tissue, intraosseous or periosteal locations [1,2]. The lesions may be unilocular or multilocular. A jelly-like fluid can be aspirated from the lesion.

Ganglia may present as an obvious swelling on physical examination, or may only be manifested by joint (particularly wrist) pain. Most wrist ganglia originate from the palmar capsule near the radioscaphocapitate ligament and are not caused by ligamentous disruption, soft tissue edema, or intraosseous communication [3].

The diagnostic approach depends upon the physical examination:
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