Ganglion Cyst on the Outer Part of the Wrist
A cyst located on the outer (dorsal) part of the wrist is called a dorsal wrist ganglion cyst. These represent 60-70% of all ganglion cysts found in the wrist area 1, 2.
Characteristics of Dorsal Wrist Ganglion Cysts
- Dorsal wrist ganglion cysts most commonly originate at the scapholunate joint 1
- They typically present as soft tissue swellings on the back (dorsal aspect) of the wrist 3
- These cysts are more common in women and typically occur during the second through fourth decades of life 4
- Many patients seek medical attention due to the cosmetic appearance of the cyst or fear of malignancy, though most are asymptomatic 3, 4
Diagnostic Approach
- Diagnosis primarily relies on history and physical examination 5
- Ultrasound is recommended as the initial imaging modality to confirm the fluid-filled nature of the cyst 5, 6
- MRI is reserved for suspected occult ganglion cysts or when there's concern about solid tumors 5, 7, 6
- MRI can also help distinguish ganglion cysts from other soft tissue masses that may appear in the wrist 8
Management Options
- Observation is acceptable in most cases, as approximately 58% of cysts will resolve spontaneously over time 3, 4
- Surgical excision is considered when symptoms such as pain, weakness, or range-of-motion deficits impact daily activities 1
- Open excision is the standard surgical treatment (gold standard) for dorsal wrist ganglion cysts 1, 2
- Arthroscopic excision is a minimally invasive alternative with less scarring and faster recovery, but similar recurrence rates to open excision 1, 9
Important Considerations
- Recurrence rates after open excision (4-9%) are significantly lower than after aspiration (15-90%) 1, 3
- Complications of surgical excision may include persistent pain, especially in patients whose activities require forceful wrist extension 1
- Follow-up with physical examination with or without ultrasound every 6-12 months for 1-2 years is recommended to ensure stability after conservative management 7
- MRI should be repeated at least every 6 months until resolution for patients with persistent symptoms 5
Clinical Pearls
- When conducting an open excision, identifying the stalk of the cyst is beneficial to prevent recurrence 1
- For large cysts adhering to surrounding soft tissue, rupturing the ganglion can facilitate easier deep dissection 1
- Care must be taken during excision to avoid damage to the scapholunate interosseous ligament, which could lead to instability 1
- The posterior interosseous nerve courses past the 4th dorsal compartment and may be injured during deep dissection 1