Channel: nabil ebraheim

Category: Education

Tags: dorsaltreatmentorthopaedicsdr. nabil ebraheimutmcgangliondiagnosiswristsymptomsnathan elkinssignsvolarmanagmentut

Description: Dr. Ebraheim’s educational animated video describes ganglion cysts of the wrist. Follow me on twitter: twitter.com/#!/DrEbraheim_UTMC Find me on Instagram @OrthoInitiative Ganglion cyst of the wrist Ganglion cyst of the wrist is a very common hand mass. It is not a tumor. It is basically a cyst that is filled with gelatinous fluid and it transilluminates. Transilluminate means that it transmits light through it. What is a ganglion cyst? Nobody really knows the exact cause of a ganglion cyst, but it seems that the cyst is filled with fluid, either from the tendon sheath or from the joint. The ganglion cyst of the wrist can be either on the dorsal aspect or the volar aspect of the wrist. The dorsal type is common and it is not as bad as the volar type. It arises from the scapulolunate articulation as shown here. The volar type is not as common and it can compress the radial artery or compressing the nerve (median nerve and ulnar nerve). The volar cyst can be bad, compromising the circulation in the hand. Volar type arises from the radiocarpal joint, which is the wrist joint. How does the ganglion cyst present itself? Usually the ganglia itself does not cause any symptoms. It looks like a well-defined mass or a bump that is localized, smooth and not attached to the skin. If it is in the dorsal aspect, it becomes very obvious when you flex the wrist. If it is a volar ganglia, it becomes obvious when you extend the wrist. The patient is more concerned about the look and the cosmesis. When you examine the patient, you want to make sure that the volar ganglia does not affect the circulation of the hand, so we do something called the "Allen's test ". The Allen's test will evaluate the flow of the circulation in the radial and ulnar arteries. The MRI is not routinely done, but if it is done for whatever reason, then there is usually a fluid signal within the mass. Ultrasound is a good study to see the relationship between the volar cyst in the artery. Ultrasound is also good when you try to aspirate the ganglion cyst that is near the artery. It is not a tumor, so we do not do a biopsy. Treatment • Usually observation • Aspiration (in some cases) o Put the needle in and aspirate the fluid o Try to avoid aspiration of the ganglion cyst in the volar aspect because it is near the artery. o If you want to do aspiration of the volar ganglion cyst then you need to have the wrist hyperextended (try to see the artery and displace it away from the cyst) and use an ultrasound to guide you in aspiration of the cyst. o Aspiration is usually done for the dorsal ganglion cyst (high recurrence rate of about 50%) o There is not much of a risk and aspiration of the dorsal ganglion cyst • Surgery o Done for severe symptoms and if the ganglion cyst is painful or if there is neurovascular compromise. o When you excise the cyst, you resect the capsule and the stalk (tract the root and excised the root of the cyst) o The cyst comes back in about 10% if it is in the dorsal aspect o Recurrence rate is about 20% if it occurs in the volar aspect o It is imperative to do the Allen's test to check the blood flow before you excise the volar ganglion cyst