Original Communications
Occult scapholunate ganglion: A cause of dorsal radial wrist pain*,**,*,**

https://doi.org/10.1053/jhsu.1999.0225Get rights and content

Abstract

There are multiple causes for chronic dorsal wrist pain over the scapholunate ligament, including occult dorsal carpal ganglion cyst, scaphoid impaction syndrome, dorsal carpal capsulitis, distal posterior interosseous nerve syndrome, and dynamic scapholunate ligament instability. Patients with such pain often have normal x-rays. A retrospective study of 21 patients undergoing surgical exploration for chronic dorsal radial wrist pain who had no palpable cyst and normal x-rays revealed that 18 of the patients had occult scapholunate ganglion cysts or myxomatous degeneration within the scapholunate ligament. All had failed long-term conservative management. Surgery involved an approach through Langer's lines, resection of a large triangular portion of the capsule between the dorsal intercarpal and radiotriquetral ligaments, and tangential debridement of the area of myxoid degeneration proximal to the distal 2 to 3 mm of dorsal scapholunate interosseous ligament. None of the patients had scapholunate instability or scaphoid impacting syndrome. Of the 18 patients with histologically confirmed myxomatous changes in the scapholunate ligament, 16 had an excellent outcome as defined by rigorous criteria; 1 had a good outcome. There was 1 patient with a poor result. A compelling argument is made for surgical exploration of the scapholunate joint in patients with persistent dorsal radial wrist pain and scapholunate point tenderness. (J Hand Surg 1999;24A:225–231. Copyright © 1999 by the American Society for Surgery of the Hand.)

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)

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    Citation 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).

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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

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