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Ganglion of Tendon Sheath M67.40 727.42

retinacular cyst picture 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:retinacular cyst, ganglion of tendon sheath

Retinacular cyst ICD-10

Retinacular cyst ICD-9

  •  727.42 Ganglion of tendon sheath

Retinacular cyst Etiology / Epidemiology / Natural History

  •  etiology is unknown, thought to be related to mucoid degeneration of collagen tissue.
  • Most common in the flexor tendon sheaths of the hand

Retinacular cyst Anatomy

  •  Cyst are filled with viscous, jellylike clear mucin.

Retinacular cyst Clinical Evaluation

  •  Firm, smooth, tender nodule / mass in the hand.  Generally very firm, pea sized. 

Retinacular cyst Xray / Diagnositc Tests

  • Hand xrays generally normal.
  • No further imaging is generally needed. 

Retinacular cyst Classification / Treatment

  • Aspiration / disrupting lesion with multiple punctures : recurrence rate = 13% to 100% (Zubowicz VN, J Hand Surg [Am] 1987; 12:618)
  • Surgical excision: cyst must be excised at the origin to include a small portion of the tendon sheath to prevent recurrence. 
  • We again discussed the natural history and both operative and non-operative treatment options.  All questions were answered.   We discussed the risks of surgery including, but not limited to: infection, recurrence, CRPS, deep vein thrombosis, pulmonary embolus, nerve or vascular injury, stiffness, incomplete relief of pain, incomplete return of function, need for further surgery and the risks of anesthesia including heart attack, stroke and death.  After discussion they elected to proceed with surgery.   

Retinacular cyst Associated Injuries / Differential Diagnosis

  •  

Retinacular cyst Complications

Retinacular cyst Follow-up Care

  •  Gentle ROM, activity limitations for 2 weeks to allow incision healing

Retinacular cyst Review References

  • Plate AM, JAAOS 2003;2:129-141

 

 

 

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