Classic history and presentation: The most common presentation is a painless mass on the dorsal wrist. However, the lesion can be associated with pain with resisted wrist motion, stiffness, and weakness, as well as paresthesia if the cyst is associated with compression of neural structures.
The majority of wrist ganglion cysts are on the dorsal wrist, followed by cysts on the volar wrist, and then cysts associated with the flexor tendon sheath. Dorsal and volar wrist ganglion cysts are typically associated with a pedicle that communicates with a joint in the wrist.
- The prevalence of ganglion cyst of the wrist is 19% in patients with wrist pain and has been incidentally found in up to 51% of asymptomatic individuals on MRI evaluation.
- Age – It is most commonly seen in individuals in the third through fifth decades of life.
Pathophysiology: The mechanism for development of the lesion has not been fully elucidated. The cyst typically has a pedicle that communicates to an adjacent joint. Contrast has been shown to communicate with the cyst when injected into the joint. However, contrast traveling from the cyst to the joint following injection into the cyst has not been observed, leading to the proposal that a one-way valve may exist within the pedicle. In addition, there is no synovial lining to the cyst seen on microscopic examination, indicating the lesion does not represent a true cyst.
Related topic: ganglion cyst