Swelling on Wrists

 

Swelling on wrist on midline on dorsum 

   Soft and cystic swelling are suggestive of Ganglion cyst. 

    2/3rd arise from Radiocarpal joint. 

    1/3rd arise from Scaphotrapezoidal joint. 

Histological Definition 

    fluid filled cavity lined by compressed collagen and a few cells.

    

Clinical Tests 

    Compressible 

    Transilluminate

Investigation 

    Ultrasound

    MRI 

    Biopsy

General Sites 

    volar side of wrist ( RS joint)

     dorsal side of wrist (SL Lig.)

     DIP Joints of digits- present as dorsal distal ganglion or mucoid                                         cyst

      A2 Pulley region in relation to flexor tendon sheath.

     Intraosseous Ganglion - uncommon ,often in lunate.

    

  Treatment 

Simple Observation

Outpatient Procedure - Simple aspiration under Local Anaesthesia

            Risks- haematoma, infection,radial artery damage,recurrence

Surgical Excision (Open or Arthroscopic )

             Risks - anaesthetic and 

                        surgical - nerve/vessel damage

                                        tendon injury

                                        haematoma

                                        infection

                                        pain/swelling/tenderness/stiffness

                                        recurrence

Risk of recurrence are same for all three treatment methods.