Volar retinacular cysts are tender masses (ganglion cysts) that typically present near the base of the finger on the palm side (volar), and, although benign, can cause pain, especially when gripping an object. Volar retinacular cysts may also be called flexor tendon sheath ganglions, as they arise from the tissue surrounding the tendon sheath of the finger (first annular, A1, pulley). The third most common type of ganglion, retinacular cysts are filled with jelly-like fluid, much like the lubricating fluid in joints, and are connected to the affected tendon sheath, similar to a balloon on a stalk.
These usually solitary cysts most often appear suddenly and can vary in size. While many ganglion cysts can be painless, volar retinacular cysts often cause pain and can affect hand function. Volar retinacular cysts most commonly affect the middle finger, followed by the index finger, ring finger, little finger, and lastly, the thumb.
Unlike typical ganglion cysts, volar retinacular cysts often do not increase or decrease in size in relation to activity level. Studies do show that retinacular ganglions resolve spontaneously in approximately 50% of cases, so if pain level is low, a wait-and-see approach for treatment may be enlisted.
Research also indicates:
- Ganglion cysts affect more women than men
- Previously injured tendons or joints are more susceptible to ganglions
- Ganglion cysts are most common in patients ages 15-40
What Causes Volar Retinacular Cysts (Ganglion Cysts)?
As with most ganglion cysts, the cause of volar retinacular cysts is not always clear. There is some evidence that these ganglions form when the tendon sheath becomes weakened and herniates. The cyst then remains connected to the sheath. Patients who have had tendon injuries in the hand, therefore, can be more likely to experience volar retinacular cysts. Osteoarthritisin the fingers may also increase the risk of developing flexor tendon sheath cysts.
Diagnosing Volar Retinacular Cysts (Ganglion Cysts)
Diagnosing a volar retinacular cyst will involve a physical examination during which your orthopedic specialist will likely gather information such as:
- How long the ganglion cyst has been present
- Whether the ganglion cyst size changes
- Pain associated with the affected area
Your doctor may palpate or apply pressure to the area to identify tenderness. He/she may also shine a light on the cyst to confirm that the core is a translucent fluid and therefore a ganglion.
Occasionally, imaging tests, such as x-rays or an MRI, may be administered in order to rule out conditions such as bone tumorsor arthritis, however, these tests are utilized more often in cases of occult (not outwardly visible) ganglions.
Treatment of Volar Retinacular Cysts (Ganglion Cysts)
If a volar retinacular cyst is causing pain or interfering with hand functionality, two main treatments are available. The orthopedic hand surgeonsat OSMI of Ft. Worth initially recommend the most conservative and effective treatment available. The most common non-surgical treatment for volar retinacular cysts is aspiration.
Aspirating the retinacular cyst involves numbing the surrounding area, inserting a needle into the cyst, and draining the fluid. In some cases, the cyst may be punctured in multiple locations or the cyst wall torn in order to decompress the ganglion. Although recurrence after volar retinacular cyst aspiration is possible, it is less common than with other ganglion cyst aspirations, as retinacular cysts recurrence after aspiration is less than 30%.
In cases in which the cyst recurs, it is usually due to the “stalk” remaining intact, much like leaving the root of a weed during removal.
Surgical Treatment for Volar Retinacular Cysts (Ganglion Cysts)
If the cyst is unresponsive to non-surgical treatments or has recurred, your orthopedic surgeon will likely recommend surgical removal of the volar retinacular cyst. During excision, the cyst will be removed, as well as the section of flexor tendon sheath that the cyst originated from to prevent recurrence. Cyst removal is performed on an outpatient basis and is a relatively quick procedure.
After surgery, you will be given detailed instructions on caring for the affected area, including keeping it clean and dry for a specified time period. There are no sutures to remove, as they are placed under the skin and are absorbable. Special tape will be covering the surgical site to protect the area and decrease scarring.
You will be given some limitations on lifting/gripping, and complete recovery may take several weeks. Surgical removal of volar retinacular cysts has an extremely high success rate with low risk and low recurrence rate.
If you are experiencing pain from a volar retinacular cyst and would like an evaluation, please contact the OSMI office in Fort Worth for an appointment with one of our highly experienced surgeons.