Most Common Location for Tendon Sheath Cysts on the Hand
The volar (palmar) aspect of the wrist at the distal wrist crease is the most common location for tendon sheath cysts (ganglion cysts) on the hand, followed by the dorsum of the wrist, with flexor tendon sheath cysts being relatively uncommon. 1, 2
Anatomic Distribution
Primary locations in order of frequency:
- Dorsal wrist: Accounts for approximately 42.7% of hand and wrist ganglion cysts, representing the single most common site 3
- Volar (palmar) wrist: Comprises approximately 31.2% of cases, typically located at the distal forearm/wrist crease where the flexor tendons pass 1, 3
- Flexor tendon sheath: Represents approximately 18.5% of cases, occurring along the palmar aspect of the fingers 3
- Extensor tendon synovial lining: Accounts for approximately 5.1% of cases 3
Clinical Context
Ganglion cysts are the most common mass lesions of the hand and wrist, accounting for 50-70% of all masses identified in this region 2. While the dorsum of the wrist is technically the single most frequent site, volar wrist ganglions arising from the flexor tendon sheath at the wrist crease are the second most common presentation 1, 2.
Important anatomic considerations:
- Volar wrist ganglions are positioned deep and maintain close relationships with the radial artery and median nerve, making them clinically significant despite being less common than dorsal cysts 1
- Flexor tendon sheath ganglions at the A1 pulley level (particularly in the thumb) are rare but can cause triggering symptoms 4
- The American College of Radiology recommends ultrasound as the preferred imaging modality to confirm diagnosis and assess anatomic relationships 5, 6
Natural History
Spontaneous resolution occurs in approximately 62.6% of untreated cases, with flexor tendon sheath cysts showing the highest resolution rate at 81%, compared to 51.9% for volar wrist ganglions 3. Cysts present for more than 12 months at initial evaluation are less likely to resolve spontaneously (41.2% versus 67.1%) 3.