Original CommunicationsOccult scapholunate ganglion: A cause of dorsal radial wrist pain*,**,*,**
Section snippets
Materials and methods
A retrospective study was conducted that included all patients who underwent surgical treatment (by senior author W.B.K.) for chronic dorsal radial wrist pain at the Indiana Hand Center between 1985 and 1993. Twenty-one patients presented with dorsoradial wrist pain and exquisite point tenderness directly over the scapholunate interosseous ligament of 3 months to 3 years' duration without a palpable mass; all had normal x-rays. Physical examinations of the wrist were otherwise normal; there was
Results
Ten of the 21 patients remembered a specific traumatic event that was followed by the chronic dorsal radial wrist pain. Four of the 10 had a history of a minor single traumatic event (ie, lifting a coffee cup [patient 3]) while 6 had more significant trauma (ie, wrist hyperextension during a motor vehicle accident [patient 1]). The other 11 patients had gradual onset of pain without a known history of trauma. Physical examination revealed exquisite tenderness directly over the scapholunate
Discussion
Twenty-one patients underwent exploration of the dorsal radial aspect of the wrist for chronic pain and tenderness over the scapholunate ligament. None had other objective findings. This confirms the high likelihood of an occult dorsal scapholunate ganglion as the cause of pain in the presence of an otherwise normal wrist examination and normal x-rays. All patients presented with exquisite tenderness over the scapholunate joint but no palpable masses and normal plain x-rays. Surgical pathology
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Cited by (31)
Physical examination of the wrist: Useful provocative maneuvers
2015, Journal of Hand SurgeryCitation Excerpt :Wrist pain with local tenderness of the dorsal SL joint (without swelling) is one of the more common patient symptoms seen by a hand surgeon. Except for rare conditions, only 4 diagnoses mimic chronic SL injury and normal wrist x-rays (including an axial-loading grip view and an ulnar deviation anteroposterior view through the SL ligament, compared with the healthy contralateral side) (Fig. 9): (1) occult dorsal carpal ganglion cyst; (2) scaphoid impaction; (3) dorsal carpal impingement syndrome, sometimes referred to as type II gymnast’s wrist; and (4) dynamic or pre-dynamic SL instability, which should not to be confused with type I gymnast’s wrist, or premature physeal closure of the palmar-medial growth plate of the distal radius as a result of-term, repetitive superphysiologic load.4 Occult dorsal carpal ganglion cysts are common but difficult to diagnose, even with adequate history and physical examination.
Arthroscopic Management of Dorsal Wrist Impingement
2008, Journal of Hand SurgeryCitation Excerpt :This is in contrast to Watson's treatment of dorsal wrist syndrome, in which, through an open approach, the dorsal ridges of both scaphoid and lunate are removed.2 Other authors have focused on the key step of removing a patch of dorsal wrist capsule in the open surgical treatment of dorsal wrist syndrome or occult dorsal wrist ganglion.3,4 The goal of arthroscopic surgery is also to remove the thickened, painful section of joint capsule that is trapped between the ECRB and the scaphoid (Fig. 1).
Wrist and hand: Treatment options
2007, Musculoskeletal Disorders in the Workplace: Principles and PracticeInter-Carpal soft tissue entrapment. A possible explanation for chronic dorsal wrist pain
2006, Journal of Hand SurgeryThe prevalence of wrist ganglia in an asymptomatic population: Magnetic resonance evaluation
2005, Journal of Hand SurgeryCompression of the posterior interosseous nerve at the Wrist
2004, Chirurgie de la Main
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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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Reprint requests: William B. Kleinman, MD, The Indiana Hand Center, 8501 Harcourt Rd, Indianapolis, IN 46280.
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J Hand Surg 1999;24A:225–231
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0363-5023/99/24A02-0001$3.00/0