Joe A Shaw PA-C - 10/22/2008

Question
The description below is a summary of the results of an MRI on my left wrist.  I am 47.  Will this require surgery?


Technique: Cor T1 and STIR, Ax T1 and T2, Sag T2. This exam was
performed on a 0.2 T Artoscan C extremity MRI system.
Bony structures: A 7 mm diameter cystic lesion is present in the proximal ?radial
aspect of the lunate bone. This lesion contains edematous soft tissue signal intensity
material, and is surrounded by extensive marrow edema. There is no evidence of
fracture or avascular necrosis. The remainder of the carpal bones are normal. The
distal radius and ulna are normal.
Articular Structures: The cartilage surfaces appear smooth and normal. No
degenerative or inflammatory arthropathy is evident. A physiologic volume of joint fluid is
present.
Ligaments: The triangular fibrocartilage is intact, with no sign of tear or
perforation. No convincing abnormality is visible in relation to the scapho-lunate or lunotriquetral
ligaments, however perforations of these small structures cannot be reliably
excluded with MRI.
The extrinsic ligaments and volar joint capsule are intact. A 4 mm diameter ganglion is
present overlying the dorsal aspect of the scapholunate space, this may be secondary to
a tiny tear or perforation in the dorsal wrist capsule.
Tendons: Normal.
Summary:
1. The cystic lesion in the lunate likely represents an intraosseous ganglion,
filled with inflamed ?edematous synovium. These lesions may produce
symptoms.
2. A small dorsal wrist ganglion is present.
Dennis Janzen,

Answer
Dave,
You have a ganglion cyst..fairly common. In the old days they would whack them w a bible to burst them, hence the name bible bump.
Only requires surgery if it is bothering you ie (cosmetically or painful). Sometimes a cortisone injection into the cyst will reduce it, but it may come back. Usually they are painful for a month or so but then become asymptomatic.

I'm sorry you feel the answer is standard, but You have a rather standard MRI and diagnosis for a 47 yr old with a ganglion cyst. You did not give a history or pictures and of course no physical exam can be done. I'm not sure what other diagnosis you want to have or what else you think could be gathered from what you sent?