Ganglion of the Wrist

Question 1

Most common _______ of the hand

1) Affects ages ____ years old
(2) ______ structure that arises from capsule of a joint or a tendon synovial sheath
(3) Through degeneration or tearing of the joint capsule or tendon sheath, a connection to the joint or tendon sheath with a one way valve established. Thus synovial fluid can enter but flow freely back into synovial cavity.

Answer 1

soft-tissue tumors

1) 15-40
2) Cystic

Question 2

Dx/Tx
Symptoms
(1) Wrist
–(a) Firm nodular swelling in wrist that may vary in size and increase in size
–(b) May be painful and pain may increase with wrist motion
–(c) Cyst may be recurrent
–(d) May have sensory symptom if cyst compresses median or ulnar nerve
(2) Hand and finger
–(a) Bump at the MCP or on the dorsum of the finger distal to the DIP
c. Physical exam
(1) Visual
–(a) Smooth round multilobulated structure on the dorsoradial aspect of wrist that becomes more prominent with flexion
–(b) Usually directly over scapholunate joint
–(c) Volar radial ganglion usually is less well defined between the flexor carpi radialis tendon and the radial styloid
(2) Palpation = Sometimes tender to palpation
(3) ROM = Usually normal
(4) Muscle Test = Unremarkable
(5) Neurovascular = Typically unremarkable
(6) Special test
–(a) Ganglion will transilluminate
–(b) Solid Tumors will not

Answer 2

Ganglion of the Wrist.
Treatment
(1) Splint wrist or finger
(2) NSAIDS
(3) Consult to orthopedics for aspiration or surgical excision

Question 3

Diagnostic Tests

(1) Plain films are ____
(2) ______/_____ useful in differentiating ganglia from other types of masses

Answer 3

1) normal

2) Ultrasound/MRI

Question 4

Referral Decisions / Red Flags

(1) Persistence of a painful or bothersome cyst that recurs after ______

Answer 4

aspiration