Abstract
The dorsum of the wrist is especially susceptible to the development of ganglion cysts in the area overlying the extensor tendons or the joint space, with a predilection for the joint space of the lunate or from the tendon sheath of the extensor carpi radialis. These cysts are thought to form as the result of herniation of synovial-containing tissues from joint capsules or tendon sheaths. This tissue may then become irritated and begin producing increased amounts of synovial fluid, which can pool in cyst-like cavities overlying the tendons and joint space. A one-way valve phenomenon may cause these cyst-like cavities to expand, because the fluid cannot flow freely back into the synovial cavity. Ganglion cysts may also occur on the volar aspect of the wrist. Occurring three times more commonly in women than in men, ganglion cysts of the wrist represent 65% to 70% of all soft tissue tumors of the hand and wrist. Ganglion cysts occur in all age groups, with a peak incidence in fourth to sixth decades. Activity, especially extreme flexion and extension, makes the pain worse; rest and heat provide some relief. The pain is constant and is characterized as aching. Occasionally, the ganglion will cause a trigger wrist. Often, the unsightly nature of the ganglion cyst, rather than the pain, causes the patient to seek medical attention. The ganglion is smooth to palpation and transilluminates with a penlight, in contradistinction to solid tumors, which do not transilluminate. Palpation of the ganglion may increase the pain.
Keywords
ganglion cyst wrist, wrist pain, ultrasound sonography, ultrasound guided injection, tendinopathy, neuroma, magnetic resonance imaging
ICD-10 CODEM67.40
The Clinical Syndrome
The dorsum of the wrist is especially susceptible to the development of ganglion cysts in the area overlying the extensor tendons or the joint space, with a predilection for the joint space of the lunate or from the tendon sheath of the extensor carpi radialis ( Figs. 54.1 and 54.2 ). These cysts are thought to form as the result of herniation of synovial-containing tissues from joint capsules or tendon sheaths. This tissue may then become irritated and begin producing increased amounts of synovial fluid, which can pool in cyst-like cavities overlying the tendons and joint space. A one-way valve phenomenon may cause these cyst-like cavities to expand, because the fluid cannot flow freely back into the synovial cavity. Ganglion cysts may also occur on the volar aspect of the wrist. Occurring three times more commonly in women than in men, ganglion cysts of the wrist represent 65% to 70% of all soft tissue tumors of the hand and wrist. Ganglion cysts occur in all age groups, with a peak incidence in fourth to sixth decades.
Signs and Symptoms
Activity, especially extreme flexion and extension, makes the pain worse; rest and heat provide some relief ( Fig. 54.3 ). The pain is constant and is characterized as aching. Occasionally, the ganglion will cause a trigger wrist. Often, the unsightly nature of the ganglion cyst, rather than the pain, causes the patient to seek medical attention. The ganglion is smooth to palpation and transilluminates with a penlight, in contradistinction to solid tumors, which do not transilluminate. Palpation of the ganglion may increase the pain.
Testing
Plain radiographs of the wrist are indicated in all patients who present with ganglion cysts, to rule out bony abnormalities, including tumors. Ultrasound imaging will help determine whether a soft tissue mass of the wrist is cystic or solid ( Figs. 54.4 and 54.5 ). Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging (MRI) and ultrasound imaging of the wrist are indicated if the cause of the wrist mass is suspect ( Figs. 54.6 and 54.7 ).
