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Ganglion Cyst of Wrist

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Other Names

  • Bible Cyst
  • Ganglion Cyst

Background

  • This page refers to a ganglion cyst of the wrist, sometimes termed a bible cyst

History

Epidemiology

  • Wrist represents 80% of all ganglion cysts (need citation)
  • Most common hand mass (need citation)

Pathophysiology

Ganglion Cyst of the Wrist

Etiology

  • Three proposed origins of fluid[1]
    • May originate from within the joint, pumped into the cyst by motion of the wrist
    • From an extra-articular degenerative process resulting in cyst formation and subsequent communication to the joint
    • May originate from mesenchymal cells within the cell wall
    • It is possible that a combination of these mechanisms contribute

Location

Risk Factors

  • Female

Differential Diagnosis

Differential Diagnosis Wrist Pain

Clinical Features

  • History
    • Swelling of dorsal wrist (most commonly)
    • Onset is typically insidious without a clear injury
    • Can occur from acute injuries
  • Physical Exam: Physical Exam Wrist
    • Transilluminates (transmits light)
    • Absence of erythema, warmth
    • Firm, well circumscribed, 1-2 cm
    • Typically non-tender

Evaluation

There is a well-defined, thin-walled, lobulated anechoic lesion with the neck appearing to extend between the carpus and ulna[4]

Radiographs

Ultrasound

  • Findings
    • Hypoechoic fluid collection
    • Absence of flow on doppler or color doppler

Classification

  • N/A

Management

Ultrasound-guided Ganglion Cyst Aspiration and Injection

Nonoperative

  • Indications
    • Generally first line treatment
    • In pediatrics, 3/4 will spontaneously resolve (need citation)
  • Closed rupture
    • Home remedy, hence term 'bible cyst'
    • High recurrence rate
  • Aspiration Procedure
    • Ideally, ultrasound guided
    • Approximately half will resolve with this treatment[5]
    • No benefit with repeat aspiration[6]
  • Corticosteroid Injection
    • Somewhat controversial
    • No evidence that this is an inflammatory response
    • One study showed CSI was no better than aspiration alone[6]
  • Splinting
    • No more effective than aspiration, leads to stiffness and loss of range of motion[7]

Operative

  • Indications
    • Severe symptoms, neurovascular injury
    • Failure of conservative measures
  • Technique
    • Resection of stalk, capsule

Rehab and Return to Play

Rehabilitation

Return to Play/ Work

  • Most athletes can play through unless neurovascular symptoms

Complications and Prognosis

Prognosis

Complications

See Also

External

References

  1. ↑ Gude, Warren, and Vincent Morelli. "Ganglion cysts of the wrist: pathophysiology, clinical picture, and management." Current reviews in musculoskeletal medicine 1.3-4 (2008): 205-211.
  2. ↑ Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg. 1976;1(3):228–35.
  3. ↑ Greendyke SD, Wilson M, Shepler TR. Anterior wrist ganglia from the scaphotrapezial joint. J Hand Surg. 1992;17(3):487–90.
  4. ↑ Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 81321
  5. ↑ Richman JA, Gelberman RH, Engber WD, Salamon PB, Bean DJ. Ganglions of the wrist and digits and results of treatment by aspiration and cyst wall puncture. J Hand Surg. 1987;12(6):1041–3.
  6. ↑ 6.0 6.1 Varley GW, Neidoff M, Davis TRC, Clay NR. Conservative management of wrist ganglia: aspiration versus steroid infiltration. J Hand Surg. 1997;22(5):636–7.
  7. ↑ Jacobs LGH, Govaers KHM. The volar wrist ganglion: just a simple cyst? J Hand Surg. 1990;15(3):342–6.
Created by:
John Kiel on 3 November 2019 22:55:56
Authors:
Last edited:
26 January 2023 08:04:48
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