Magnetic resonance imaging in the diagnosis of occult dorsal wrist ganglions

Cystic Anomaly Manifestation Within the Axillary Fossa: A Case Report of Clinical Significance

Ganglion cysts represent a small group of lesions that can arise from almost any joint in the body. Demonstrating a predilection for the joints in the hand and wrist, ganglion cysts in the glenohumeral joint are extremely rare. Due to the vivid array of masses that can be found in the axillary fossa, forming a free-from-error work-up to the correct diagnosis can be quite confounding. In this paper, we present a case of a paralabral cyst of the shoulder joint, located in the axilla. With there being only eight other such cases published in clinical literature, we believe this case report to be of unique importance in gaining further insight into the genesis and treatment of this pathology.

Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Occult Dorsal Wrist Ganglion Cysts Associated with Scapholunate Instability: Surgical Technique and Preliminary Clinical Results

Background: This study aimed to evaluate our preliminary results and experience with the arthroscopic dorsal ligamentocapsulodesis in managing occult dorsal wrist ganglion cysts (ODGCs) associated with scapholunate (SL) instability. Methods: All patients who underwent arthroscopic dorsal ligamentocapsulodesis due to an ODGC with concomitant SL ligament tear were retrospectively reviewed. In addition to demographic data and length of follow-up, outcomes data that included range of motion, grip strength, modified Mayo wrist score (MMWS), complications and radiographs were collected. Results: The study included 18 patients (18 wrists; 10 female and 8 male). The mean age was 32 years (range: 19-48) and the mean follow-up was 34 months (range: 24-48). The mean preoperative extension deficit decreased from 5.5° (range: 0°-20°) to 2.7° (range: 0°-15°) at the final follow-up (p = 0.004). The mean preoperative flexion deficits decreased from 4.4° (range: 0°-15°) to 2.2° (range: 0°-10°) postoperatively (p = 0.003). The mean hand grip strength significantly increased from 27.7 kg (range: 22-36) to 38.3 kg (range: 31-46) at the final follow-up assessment (p < 0.001). The mean MMWS improved from 46 (range: 25-65) pre-operatively to 91 (range: 70-100) at the final follow-up (p = 0.0002). No major intra- or postoperative complications were observed. Conclusions: SL instability may have an important role in the aetiology of ODGCs, and arthroscopic dorsal ligamentocapsulodesis can provide pain relief and functional improvement without recurrence at the short- to mid-term follow-up in the treatment of ODGCs. Level of Evidence: Level IV (Therapeutic).

Dorsal Wrist Ganglion: Pilot for Randomized Control Trial Comparing Aspiration Alone or Combined with Injection of Platelet-Rich Plasma

This pilot study assessed the feasibility of performing a randomized control trial (RCT) investigating injection with platelet-rich plasma (PRP) for dorsal wrist ganglion (DWG). Aspiration alone was compared with aspiration plus injection of PRP. Seventeen patients were enrolled. Nine patients received PRP and eight aspiration alone. Patients were followed up at 6 weeks and 1 year; recurrence of the ganglion and Patient Evaluation Measure scores were measured. At 6 weeks seven patients in the aspiration group had a recurrence and five in the PRP group, but by 1 year, this has increased to seven out of eight in the PRP group whereas in the aspiration group four had resolved leaving three out of eight patients with a ganglion still present. From the basis of our work an RCT would require a minimum of 46 patients per group; however, it is unlikely that PRP will be a panacea for ganglia. This is a Level II study.

Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play

Wrist injuries in the competitive athlete are a common reason for evaluation related to an acute injury or after symptoms have become chronic. While radius- and ulna-sided wrist pain are common topics covered in the literature, middorsal wrist pain is more common than the available literature would suggest. Missed diagnoses and inadequate treatment can significantly increase athlete morbidity and delay return to play. The goal of this article was to review the differential diagnosis of middorsal wrist pain in the athlete and discuss the diagnosis, treatment, and early return to play for each condition.

Radiologist Identification of Occult Dorsal Wrist Ganglion Cysts on MRI

Background  Occult dorsal ganglion cysts (ODGC) require imaging or an operation for detection. It is currently unknown how often a radiologist identifies an ODGC on magnetic resonance imaging (MRI) and whether surgeon indication for MRI aids the radiologist in detection. Questions/Purposes  The aim of the study was to investigate the following questions: how accurately do radiologists identify ODGC on MRIs? What factors may be associated with missed ODGCs? Patients and Methods  We retrospectively studied patients who underwent an operation for an ODGC and had a preoperative wrist MRI. Radiology report and surgeon's notes were evaluated to determine whether identification of the ODGC was noted and whether the surgeon indicated that the MRI was to evaluate for an ODGC. MRIs were reviewed, dimensions of cysts measured and volume of cyst calculated. Results  Twenty-four patients and 25 MRIs were analyzed. The radiologist identified the ODGC in 19 cases (76%). Fifteen of the 25 MRIs (60%) ordered had ODGC listed in the requisition comment by the ordering surgeon. Thirteen of these 15 (87%) ODGCs were seen by the radiologist. Ten of the 25 MRIs (40%) ordered did not mention ODGC in the requisition. Six of these 10 (60%) ODGCs were seen by the radiologist. The volume of the ODGCs missed by radiologists was smaller (mean, 0.049 cm ³ ) than those the radiologists identified (mean, 0.31 cm ³ ; p  = 0.004). Conclusions  Radiologists will not always identify the ODGC on an MRI, but they were more likely to if the surgeon was concerned for one. Hand surgeons should report suspicion of an ODGC on MRI requisition and review all imaging independently. Level of Evidence  This is a Level III, prognostic study.

Dorsal Wrist Pain in the Extended Wrist-Loading Position: An MRI Study

Background  The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Purpose  Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). Methods  A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Results  Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). Conclusion  MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Level of Evidence  Diagnostic, Level III.

Arthroscopic resection of occult dorsal wrist ganglia

INTRODUCTION

Arthroscopic resection of dorsal wrist ganglia has become a well-accepted practice. However, there is a paucity of results on occult ganglia in the literature. The purpose of this study is to evaluate the subjective outcomes of occult dorsal wrist ganglion cysts resected arthroscopically, and to identify and examine intraarticular findings and relate them to pre-operative MRI findings and histologies.

MATERIALS AND METHODS

In 39 patients, 40 wrists were treated with arthroscopic resection of an occult dorsal wrist ganglion. Radio-carpal arthroscopy and mid-carpal arthroscopy were performed, and a capsular window overlying both compartments at the level of the scapholunate interval was created. The motivation to undergo operation for all patients was pain at rest and on load. In a retrospective study by telephone interview, patients were asked for pain reduction and satisfaction with the operation. 30 patients could be reached after 28.5 months on average.

RESULTS

29 of the 30 patients were content with the operation. Reduction of pain at rest and on load was significant. MRI was performed pre-operatively in all the cases and could confirm the presence of a ganglion in 31 cases. Intraoperatively, ganglion structures were identified in 25 cases. Histology showed ganglion tissue or myxoid degeneration in 12 of 26 taken samples. Histology was positive in the cases without intraoperative visualization of typical ganglion structures and without confirmation by MRI.

CONCLUSION

The results of this study confirm that a high patient satisfaction can be achieved for arthroscopic treatment of occult dorsal wrist ganglia, which seem especially amenable for arthroscopic treatment. Furthermore, the results suggest that arthroscopic resection of a dorsal capsular window can be indicated if the complaints and the clinical findings are typical for dorsal wrist ganglion, even though MRI findings may be negative.

Imaging of radial wrist pain. Part II: pathology

Pain on the radial side of the wrist is a common clinical presentation. Such wrist pain may provide a diagnostic challenge for radiologists, in view of the small size of the anatomic structures, the occasional subtlety of the imaging findings, the diversity of potential etiologies, as well as the non-infrequent occurrence of incidental asymptomatic findings in this area. This review discusses the imaging findings in both the more common and less common causes of radial-sided wrist pain, concentrating particularly on the detection of early disease and less readily apparent abnormalities.

MRI-identified abnormalities and wrist range of motion in asymptomatic versus symptomatic computer users

Background

Previous work has shown an association between restricted wrist range of motion (ROM) and upper extremity musculoskeletal disorders in computer users. We compared the prevalence of MRI-identified wrist abnormalities and wrist ROM between asymptomatic and symptomatic computer users.

Methods

MR images at 1.5 T of both wrists were obtained from 10 asymptomatic controls (8 F, 2 M) and 14 computer users (10 F, 4 M) with chronic wrist pain (10 bilateral; 4 right-side). Maximum wrist range of motion in flexion and radioulnar deviation was measured with an electrogoniometer.

Results

Extraosseous ganglia were identified in 66.6% of asymptomatic wrists and in 75% of symptomatic wrists. Intraosseous ganglia were identified in 45.8% of asymptomatic wrists and in 75% of symptomatic wrists, and were significantly (p < .05) larger in the symptomatic wrists. Distal ECU tendon instability was identified in 58.4% of both asymptomatic and symptomatic wrists. Dominant wrist flexion was significantly greater in the asymptomatic group (68.8 ± 6.7 deg.) compared to the symptomatic group (60.7 ± 7.3 deg.), p < .01. There was no significant correlation between wrist flexion and intraosseous ganglion burden (p = .09)

Conclusions

This appears to be the first MRI study of wrist abnormalities in computer users.

This study demonstrates that a variety of wrist abnormalities are common in computer users and that only intraosseous ganglia prevalence and size differed between asymptomatic and symptomatic wrists. Flexion was restricted in the dominant wrist of the symptomatic group, but the correlation between wrist flexion and intraosseous ganglion burden did not reach significance. Flexion restriction may be an indicator of increased joint loading, and identifying the cause may help to guide preventive and therapeutic interventions.