Teaching Case

A computer worker with pain in both wrists for more than 3 months. No trauma.

The patient presented with a history of pain in both wrists for more than 3 months, with pain in the dorsal wrist of his right hand and volar on the ulnar side of the wrist of his left hand. He had worked on a personal computer for more than 8 hours a day for several years. There was no history of trauma. No lesions were seen on plain radiographs. MRI of both wrists was performed.

MRI showed small soft tissue ganglia on both wrists: on the right wrist related to the radio-carpal joint; on the left wrist proximal to the os pisiforme and also related to the carpal joints.

Ganglia are the most common soft-tissue tumours of the wrist and hand. They consist of encapsulated mucoid fluid, often related to joint spaces or tendon sheets. Clinically occult ganglia are detected by ultrasound,which is usually the first diagnostic choice and can in most cases detect even small wrist ganglias. To evaluate the origin of the ganglion,to image the surrounding anatomy and to exclude other pathology the next diagnostic step is MRI, which can detect ganglia from a size of about 3mm. On MRI they are of high signal in T2-weighted images and of low signal in T1-weighted images and well separated from the surrounding tissue, often with direct connection to the neighbouring articular space.