Ganglion Cyst of Wrist
- Bible Cyst
- Ganglion Cyst
- This page refers to a ganglion cyst of the wrist, sometimes termed a bible cyst
- Wrist represents 80% of all ganglion cysts (need citation)
- Most common hand mass (need citation)
- See: Ganglion Cyst (Main)
- Benign cystic mass which most commonly occurs in wrist
- Three proposed origins of fluid
- 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
- Dorsal carpal (70%)
- Volar carpal (20%)
- Volar retinacular
- Dorsal DIPJ
Differential Diagnosis Wrist Pain
- Distal Radius Fracture
- Distal Ulna Fracture
- Carpal Fractures
- Essex Lopresti Fracture
- Instability & Degenerative
- Tendinopathies & Ligaments
- Pediatric Considerations
- 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
- Standard Radiographs Wrist
- Screening tool, typically normal
- Hypoechoic fluid collection
- Absence of flow on doppler or color doppler
- Generally first line treatment
- In pediatrics, 3/4 will spontaneously resolve (need citation)
- In adults, about half will resolve spontaneously
- Closed rupture
- Home remedy, hence term 'bible cyst'
- High recurrence rate
- Aspiration Procedure: Ganglion Cyst of the Wrist Aspiration
- Corticosteroid Injection
- Somewhat controversial
- No evidence that this is an inflammatory response
- One study showed CSI was no better than aspiration alone
- No more effective than aspiration, leads to stiffness and loss of range of motion
- Severe symptoms, neurovascular injury
- Failure of conservative measures
- Resection of stalk, capsule
Rehab and Return to Play
- Needs to be updated
Return to Play/ Work
- Most athletes can play through unless neurovascular symptoms
Prognosis and Complications
- Study of 219 patients comparing Surgical vs Aspiration/ Injection
- 8.4% recurrence with non surgical group vs 21.5% recurrence with surgical group
- Surgical group had more post op pain, stiffness
- Volar ganglion cysts more likely to recur without surgical excision
- Median Nerve Neuropathy
- Hand Ischemia
- Infection, neurovascular injury, stiffness
- Physical Examination Wrist
- Hand and Wrist Anatomy (Main)
- Hand Pain (Main)
- Wrist Pain (Main)
- Forearm Pain (Main)
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
- Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
- 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.
- 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.
- Greendyke SD, Wilson M, Shepler TR. Anterior wrist ganglia from the scaphotrapezial joint. J Hand Surg. 1992;17(3):487–90.
- Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 81321
- 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.
- 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.
- Jacobs LGH, Govaers KHM. The volar wrist ganglion: just a simple cyst? J Hand Surg. 1990;15(3):342–6.
- Paramhans, D, Nayak, D, Mathur, R, Kushwah K. Double dart technique of instillation of triamcinolone in ganglion over the wrist. J Cutan Aesthet Surg. 2010 Jan-Apr;3(1):29–31.
- Gude, W, Morelli, V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):205–211.