Ganglion Cyst of Wrist
Other Names
- Bible Cyst
- Ganglion Cyst
Background
- This page refers to a ganglion cyst of the wrist, sometimes termed a bible cyst
History
- Needs to be updated
Epidemiology
- Wrist represents 80% of all ganglion cysts (need citation)
- Most common hand mass (need citation)
General
- See: Ganglion Cyst (Main)
- Benign cystic mass which most commonly occurs in wrist
Etiology
- Three proposed origins of fluid[2]
- 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
- Dorsal carpal (70%)
- Most commonly originates from Scapholunate Ligament[3]
- Volar carpal (20%)[4]
- Volar retinacular
- Dorsal DIPJ
Risk Factors
- Female
Differential Diagnosis
- Ganglion Cyst of Wrist
- Lipoma
- Synovial Cyst
- Abscess
- Neuroma
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
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
Radiographs
- Standard Radiographs Wrist
- Screening tool, typically normal
Ultrasound
- Findings
- Hypoechoic fluid collection
- Absence of flow on doppler or color doppler
Classification
- N/A
Management
Nonoperative
- Indications
- 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[8]
- Cock Up Wrist Splint
- No more effective than aspiration, leads to stiffness and loss of range of motion[9]
- Can consider after a steroid injection to reduce the "pump effect"
Operative
- Indications
- Severe symptoms, neurovascular injury
- Failure of conservative measures
- Technique
- Resection of stalk, capsule
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Most athletes can play through unless neurovascular symptoms
Prognosis and Complications
Prognosis
- Study of 219 patients comparing Surgical vs Aspiration/ Injection[10]
- 8.4% recurrence with non surgical group vs 21.5% recurrence with surgical group
- Surgical group had more post op pain, stiffness
- Recurrence
- Volar ganglion cysts more likely to recur without surgical excision[11]
Complications
- Median Nerve Neuropathy
- Hand Ischemia
- Cosmesis
- Postoperative
- Infection, neurovascular injury, stiffness
See Also
Internal
- Physical Examination Wrist
- Hand and Wrist Anatomy (Main)
- Hand Pain (Main)
- Wrist Pain (Main)
- Forearm Pain (Main)
External
- https://www.sportsmedreview.com/blog/review-on-ganglion-cysts/
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ 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.
- ↑ Sbai, Mohamed Ali, et al. "Pseudotumoral form of soft-tissue tuberculosis of the wrist." International journal of mycobacteriology 5.1 (2016): 99-101.
- ↑ 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.
- ↑ 8.0 8.1 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.
- ↑ 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.
Created by:
John Kiel on 3 November 2019 22:55:56
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Last edited:
9 August 2024 17:01:55
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