Why dorsal ganglion cysts are painful - MRI tips and tricks for ganglion cysts

In this video I cover tips and tricks and potential pitfalls regarding ganglion cysts when reading wrist MRI. In addition I cover where these ganglion cysts most frequently occur and which are important and which are not.
Very important: Do not mistake recesses such as the pisotriquetral recess or the prestyloid recessus for ganglion cysts. That is actually a common pitfall.
Radiovolar ganglion cysts are so common, and some authors argue that they are not even ganglion cysts but physiological recesses (which would explain why nearly everybody has it).
Also be very sensitive when looking for dorsal ganglion cysts over the scapholunate ligament (SL-ligament) or along the dorsal intercarpal ligament. They might compress the sensory branch of the posterior interosseous nerve.
#Wrist #GanglionCyst #MRI
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[@VoldoDance]

Fantastic as always!!

[@bernardomedellin8997]

Great video as always. Haven't seen your newest videos yet, but it would help a lot if maybe in the lower left corner of the MRI images you included the sequence. Thanks again, and hope to catch up w the content soon.

[@DrChristophAgten]

Thanks Bernardo for the suggestion. In my latest I did exactly that. Not all through the video though.

[@anandrahalkar]

great video. really understood those dorsal ligaments and can now see them on MRI. Thanks

[@DrChristophAgten]

Great to hear!

[@rdkim976]

i'm happy i found you. I'm a radiologist working in korea. Your channel is really helpful.

[@DrChristophAgten]

Thanks! Please spread the word 😉

[@RADKIT]

Great video, very informative and concise, I have a very small suggestion though, the sound of the music is relatively very high when you're talking making it a bit harder to hear you.

[@immane75]

Please do a video on the hypothenar hammer syndrom . How can we suspect it on a regular non con MRI ?

[@72dee]

I had one in my 20s that was huge on back of hand right hand. Now I have one on my left hand. Base of my thumb is swollen, my tendon is swollen and tight. Reaching for thing, holding or moving my thumb in different positions are very painful. Since November 2022 before my birthday it started. It's February 27th, the ganglion cyst is growing under my skin. It's causing issues with my tendon. I have a appointment for a MRI in couple days. But yes mine is causing chronic pain

[@sarahhardy8649]

Speaking as one with a confirmed volatile ganglion I can confirm that it does have associated pain at the location and tingling in the thumb and index finger.

[@DrChristophAgten]

thanks for sharing

[@jeevaypakistan8748]

You are very good teacher

[@DrChristophAgten]

Thanks a lot

[@riverdeep399]

Very interesting Doctor. Thank you. I have had small ganglion's before in teenhood. I rememeber my mum squashing one with a huge bible! I just discovered a troublesome on top of my wrist which is in a new area. Going to sweet talk my GP into making it vahmouse. :) Very interesting to learn about. Could a physical trauma set off a response to pull up a Ganglion? Just thinking, I do martial arts and landed a punch which left me heavily bruised for awhile, there didn't seem to be a break, but that point is exactly where this dang ganglion has puffed up and I hadn't had one for twenty years. Just curious timing... :)

[@bless2498]

I hv been operated twice but still having the operated area swollen and very hard.Please,could I do to make it go?

[@immane75]

helpfull as usual . Thank you .

[@DrChristophAgten]

thx :), if you have a suggestion what I should cover, please let me know

[@immane75]

@@DrChristophAgten Can you please do a videos on morton neuromas ? min sequences to perform ? do we need gado? main differentials .Please .

[@DrChristophAgten]

I do not think you need gado. i would scan them in prone position, with T1 and T2 axials on the forefoot, coronal STIR and eventually sag PD (e.g. Dixon) with and without FS. I will make a short video in the near future, stay tuned!

[@immane75]

Thank you , was confused about GADO since in my residency we used to perform them with gado but nobody explain why ? waiting for your video :-)

[@chompchomp88]

Me with a ulnar ganglion cyst that's symptomatic watch thing. Nice to to that I'm rare

[@ssssmmmm26]

Hi , thank you for your video! I had ganglion cyst on my wrist, it disappeared but pain is still there, ultra sound shows that there is left balloon/capsule, (3mm). My question is: what is the solution? :( i am pro violinist and it is really important for me to not have pain in my wrist. Thank you in advance for your answer!

[@dairoberts605]

Great video thanks. Do you think ganglions 'from' the dorsal SL ligament imply there is/ was a partial thickness SL ligament tear?

[@DrChristophAgten]

not necessarily, could be arising from the joint capsule as well. we frequently see normal SL ligaments despite the ganglion cyst.

[@amandawillson2333]

I have multiple cysts on my hands what should I do?

[@blackiesun]

I got a couple of them at the moment on the back of my right hand. One largish and one small. I had one before on the other hand years ago that eventually got reabsorbed by my body. They are not painful so I am leaving them be for now. If your cyst is not painful you should just leave it alone. Aspiration is ok if it is causing pain but mind you, with this there is a high chance of failure as the cyst will just reappear. Surgery is the only definitive option to get rid of it permanently and it should be a last resort only if your cyst is causing pain.

[@laurawood7571]

I’ve got a history of cysts. I had one surgically removed a few years ago. That one you could see when I bent my wrist. I’m now dealing with another one, only you can’t see it at all. I guess that’s called an occult cyst. The only reason they found it was because I had this horrendous pain in my wrist and my thumb and first 2 felt like they were going numb. At first they thought carpal tunnel since there was no obvious cyst visible on clinical exam. But the EMG was normal, so I was sent for an MRI. On the MRI they found a 3cm cyst and radial impingement. It’s some of the worst pain I’ve experienced and I’ve experienced a lot! But for some reason I’m quite clear on the doc doesn’t want to surgically remove it like he did the one I had a few years ago. So instead I’m getting an aspiration and ultrasound guided radialcrapal injection. I hope it helps, this has been miserable.

[@broskichannel4163]

What happened

[@MrArun0058]

Great video, thank you Doctor! I have a dorsal ganglion cyst measuring 10 x. 5.6mms. 3 years back, I had a TFCC surgery since I had a central tear(arthroscopy) and the doctors mentioned they removed a ganglion cyst as part of the surgery. I have been suffering from wrist pain 1 year after the surgery and recently I had a MRI and there seems to be a ganglion cyst in the exact same location. I have tried aspiration a couple of years back but it did not help. It hurts a lot and I am not sure what to do next. Kindly advise as it bothers me a lot. Thanks again!

[@DrChristophAgten]

gangion cyst aspiration has a high chance of recurrence. talk to your hand surgeon about options. good luck!

[@nicobehnke4325]

Schöner Kanal, schade, dass ich ihn erst jetzt gegen Ende meiner Assistenzarztzeit entdeckt habe. werde jetzt nach und nach alle Videos abgucken. Jetzt tauchen sogar NFTs auf, habe ich gesehen. du gehst mit der Zeit, gefällt mir ;)

[@DrChristophAgten]

willkommen Nico!

[@YamanAldous]

Hi Dr Christoph, how working out and lifting weights could affect the cyst, do you think it makes things worse or it may help strengthen the wrist and reduce the soreness. Thanks in advance

[@DrChristophAgten]

Thank you Yaman for your question. Please discuss this with your doctor. I cannot give medical advice here. Thank you for your understanding.

[@sarapark4823]

Did you get an answer from any doctor, yaman? I'm curious about the same thing

[@lauraironstalksms]

Hi, I've had a wrist problem for over a year now, excruciatingly painful especially on movement of the wrist backwards. I have had 3 MRI's, 1 ultrasound and a nerve conduction test. The result from the MRI read this : Mild patchy alteration of bone marrow signal. Possibly due to disuse. Bolar calant of the gascaoholunate ligament is mildly increased signal probably due to degeneration. 3mm ganglion cyst at the Bolar aspec of the tirqetril unlikely significant. There is mild soft tissue odeama of the dorsal aspect of the distal carpel row. Would you think this could be something related to a dorsal wrist pain problem? People are putting it down to a nerve related thing with my MS but its over a year now and I'm not convinced. Any help would be appreciated. Thanks Laura

[@DrChristophAgten]

Hi Laura, sorry to read about your problems. cant comment based on some text, wouldn't be serious, so I am afraid, i cant help. However, tiny ganlgion cyst at the right location can compress neural structures. If you require a second opinion contact me via email. all the best and stay safe

[@ekkuara]

I have gone through ultrasound and x-ray and report says 12x4x16mm ganglion cyst arising from dorsal aspect of the radio scaphoid joint. The wrist tendons are intact. No tendon sheath fluid. No evidence of joint effusion. Please give me advice now I am not able to do my pushups, handstand etc. In hand movements no pain comes but when I put pressure to do pushup or handstand pain comes this is constant for last 5-6 months. Please suggest..

[@DrChristophAgten]

can't give medical advise here, please contact your doctor about this,

[@taracumming9920]

I have three of these withing my wrist, causes pain up my arm will I need surg?

[@DrChristophAgten]

Please consult with your doctor. good luck.

[@Brajvasi_rajput]

My MRI reads subchrondal cystic area with Marrow edma along lower side of ulna... It pains while putting pressure Will i need to get a surgery....

[@DrChristophAgten]

thanks for sharing

[@jessebetteridge1116]

Please help me I have a Ganga lion on the top of my wrist/hand and I’m in absolute pain and it’s killing me I tried popping it with a needle but it didn’t work and I seriously can’t go in the push-up position

[@DrChristophAgten]

Ok don't do that with the needle please. Go see a doctor/wrist surgeon.

[@jessebetteridge1116]

@@DrChristophAgten Yeah I been to a doctor plenty of times and I got it drained but it came back but this time it’s worse than ever and the specialist said he dosnt wanna do surgery on me cause I’m younger and I’ll miss sport for a while

[@Taashei]

Hi i also have small dorsal cyst in my left wrist. i went to doctor had he gave me pain killer for 10 days but pain didn’t improve. then i went for ultra sound therapy for 4 sessions that to didn’t work. then doctor asked me for MRI . after MRI my doctor suggested it is small and surgery doesn’t require i will try to remove it with niddle. he did that but still i feel the pain .. not able to use my wrist completely it pains when i twist or band my wrist.. please suggest what shall i do.. ??

[@DrChristophAgten]

Get a second opinion.

[@Nami-hx6ve]

hi, does surgery impose a high risk of hitting the nerves? im scared that my nerves would get hit. i dont want to have a shaky hand since i used this to puncture dialysis patients access. huhu :(

[@DrChristophAgten]

hi Angel, surgeries are never without risk. That is a question you should discuss with your (potential) surgeon. all the best, chris

[@shrek19yearsago78]

Dr Christoph Agten is it better to just wait

[@dystopian-arc8404]

Hello doctor, I believe I have a ganglion cyst on my wrist and it pains a bit, since I am a student studying outside of my country surgery and basic diagnosis is a bit costly for me. Is there anyway I can send you a photo of my wrist so you can tell me if it is what I believe it is or something worse?!! I would be really grateful if you could help me out.

[@blackiesun]

He cannot diagnose it via a pic. He needs to be able to feel it. Anyway it is most likely a cyst. 99% likely so don’t worry.

[@samkid1658]

Are subchondral cyst same as occult ganglion cyst ? My mri said that i have subchondral cyst in the scapho trapezoid joint ... i have sharp pain in that area when doing things like pushup etc . Just wanted to ask you about it please reply.

[@DrChristophAgten]

its not the same

[@Andrew22]

I have one in my right hand wrist. If I continue to do push ups even when its unbearably painful, could that cause any serious problems? Or would it just pop?

[@_er11_]

Same here I have it right in the middle of the top of my wrist and whenever I try to do a push up it hurts. The weird thing is after like a week or two it goes away but if I land on my wrist it comes back

[@riverdeep399]

Andrew That is the exact reason I am here. It is impacting my sport heavily. I feel, aside from the pain, that the integrity is compromised I feel like my wrist will just give way. I've had cysts before but they weren't bothersome. All the best with your case :)

[@riverdeep399]

@@_er11_ I have just discovered the lump, but had the pain/ lack of strength for months now. It's pretty irritating. I hadn't noticed the lump until I landed a movement wrong and I think that trauma may have brought it out more? Best of luck with your case also. :) When Covid is done I'm hoping to get mine excised out.

[@foroloca6148]

@@_er11_ I have the same symptoms for years (can’t do push-ups) and I was wondering if you had any improvement or treatment?

[@nickyg9483]

I’ve had a small lump on top centre of my wrist for the past year, if I bend my hand back it gives me pain, but the last week the pain is everyday, and a really bad pain, I can’t put any weight on my hand, the lump is only small, is this what it could be?

[@DrChristophAgten]

Can't give you medical advice here. Consult with your GP. I offer second opinions for MRI scans through, should you have one

[@lindseyhiccups]

Hey, did it turn out to be a ganglion cyst? I have the exact same symptoms and will need to phone the doctor on Monday morning 😬 so I'm kinda wondering how you're getting along now with it

[@Smash_ter]

I have a bump dead center on the wrist which was identified as a ganglion cyst. It is not visible when the hand is flat but is noticable when bending my hand. Although it is not big it causes discomfort at random times, with it being uncomfortable at this current moment. This cyst has been sitting there a lot longer than the other ganglion cysts I've had. What should I do?

[@DrChristophAgten]

I am not the right person to ask, sorry

[@megmudkipz]

i know i’m very late but i have the same issue some doctors are telling me it’s a cyst but it goes away when my wrist is flat mine is very painful

[@broskichannel4163]

Im pretty sure i have the same, have you managed to get rifd off it?

[@broskichannel4163]

has it gotten better?@@megmudkipz

[@joelflack1469]

​@@broskichannel4163 I have the same goes away when wrist is glate but visible when bent and is painful. Have you heard anything?

[@moss6792]

Hey. Ive had mine for 4 years right in the middle of my left wrist. Its so deep in the wrist and i cant do anything with my wrist without it hurting so bad. I also have numbing and aches in my wrist and elbow. Do you know what i could do to help the pain/numbing? Ive done ice, heat, compression, massage, medication, physical therapy, ect. And it hasnt gotten better. (The nerve is the posterior interosseous) i am getting surgery for the cyst and part of the nerve being cut, but the surgery is cancelled bc of the epidemic and i cant take the pain any longer lol. It also sucks bc im studying to be a physical therapist next year and i cant even get this done before going in.

[@acertainlittlerabbitholed7239]

I e been dealing with mine for over a decade best thing to do is never bend your wrist the pain will subside I promise I tried smacking it with a book....I wanted to cut my hand off! The pain was excruciating 😖 I’ve learn to never flex my wrist too far and I get by in life

[@zealanddublin9047]

@@acertainlittlerabbitholed7239 Try surgery.

[@taracumming9920]

Does compression cause tingling up the arm?

[@DrChristophAgten]

yes, that can happen

[@tysonmom1]

Dr. Agten, I had TFCC debridment arthroscopic surgery 1/7/19. I also had 2 pain nerves removed a couple of inches above my wrist. I still have pain in the area right next to the ulnar head on the side, going toward the inside of the wrist. It hurts more when I turn my palms up (supination) using my whole hand/arm. I'm worried I have another tear somewhere. I'm a competitive tennis player, right handed, and I haven't been able to play for almost a year now:( Any suggestions as to what might be going on would be appreciated.

[@DrChristophAgten]

Dear Paula, sorry to hear about your suffering. Unfortunately, I cannot give you a specific diagnosis of treatment over the internet. Check back with your surgeon and if you are unhappy with it get a second opinion. I wish you all the best.

[@Shanwazgacs]

Doctor will injury leads to gout attack

[@DrChristophAgten]

not really