In this radiology lecture, we review the ultrasound appearance of ganglion cysts while highlighting relevant wrist ultrasound anatomy!

Key teaching points include:

• Ganglion cysts are viscous, mucin-filled collections lacking a synovial lining


• Most commonly occur at hand/wrist = Most common wrist mass


• Location: Dorsum of wrist (60%), frequently adjacent to scapholunate ligament; volar wrist (20%), often between radial artery and flexor carpi radialis tendon; flexor tendon sheath (10%); associated with DIP joint (10%)


• Grows out of tissues surrounding joint like a balloon on a stalk. May see a pedicle connecting to joint


• Usually well-defined and multilocular, can be unilocular


• Hypoechoic to anechoic with posterior acoustic enhancement


• Noncompressible: Dorsal joint recess and bursal collections will typically collapse with transducer pressure or wrist movement


• Typically no vascular flow, but septations may have vascularity. May see pulsation artifact from adjacent radial artery


• Volar cysts can extend towards median nerve and may cause carpal tunnel syndrome


• May displace or envelop radial artery


• Tx: Watchful waiting, percutaneous US-guided aspiration and steroid injection, excision


• Lister’s tubercle is a useful landmark for dorsal wrist anatomy


• Relevant dorsal extensor tendons (from radial side to ulnar): Compartment 2 = Extensor carpi radialis longus, extensor carpi radialis brevis, Compartment 3 = Extensor pollicis longus (on ulnar side of Lister’s tubercle), Compartment 4 = Extensor digitorum and extensor indicis


• Flexor carpi radialis overlies the ventral aspect of the scaphoid bone


• Pisiform and scaphoid bone form the proximal “twin peaks” of the carpal tunnel at the ventral wrist crease


• Median nerve diameter increase of 2 mm2 or more = Significant compression

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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