Presentation
Dorsal wrist swelling for the last few months. No trauma.
Patient Data
There is a well-defined, thin-walled, non-compressible, anechoic lesion on the dorsal aspect of the wrist. Acoustic enhancement is present. There is no calcification/ vascularity.
The lesion overlies the dorsal aspect of the scapholunate region, superficial to the 2nd extensor compartment. It is deep to the 4th extensor compartment. The approximate size of the lesion is 16 x 15 x 8 mm. The neck of lesion extends to the scapholunate joint. There are tiny echogenic foci in the scapholunate joint which showed movements with changing wrist positions. They probably represent intra-articular gas. There is no associated wrist joint effusion/ extensor tenosynovitis/ tendon pathology.
Case Discussion
The case shows the typical ultrasound features of a ganglion cyst. It is a dorsal wrist ganglion cyst. Such cysts communicate through the capsule with an area of degeneration of the dorsal fibers of the scapholunate ligament3.
Ganglion cysts are the most common masses of the hand and wrist2. The commonest location of wrist ganglion cysts is the dorsal side1,3.The other locations are the solar aspect of the wrist, flexor tendon sheath, dorsal aspect of the DIP joint, finger1,3.
Other masses of hand and wrist include tenosynovial giant cell tumor, lipoma, hemangioma/ vascular malformations, fibrzomatosis, benign peripheral nerve sheath tutors, fibrolipomatous hamartoma, gloms tumor, anomalous muscle, abscess, foreign body granuloma etc1.