synonyms: intraosseous ganglion of the lunate, scaphoid, lunate cyst, cystic lunate
Intraosseous Carpal Ganglion ICD-10
Intraosseous Carpal Ganglion ICD-9
- 733.20 Cyst of bone (localized), unspecified
- 727.43 Ganglion, unspecified
Intraosseous Carpal Ganglion Etiology / Epidemiology / Natural History
- Uncommon, benign cystic lesion in the carpal bones.
- Can be bilateral and symmetrical
- Occurs in young and middle-aged adults
- Lunate most frequently affected, followed by capitate, scaphoid, and triquetrum
- Differential diagnosis of a lytic lesion in the carpals:
- Pathogenesis unknown: synovial herniation, neoplasia, metaplasia of mesenchymal precursor cells, proliferation of synovial rest cells, and traumatic mucoid degeneration of connective tissue.
Intraosseous Carpal Ganglion Anatomy
- Histology similar to that of soft tissue ganglions; cystic wall surrounded by flattened, synovial-like fibroconnective cells; focal mucoid degenerations
Intraosseous Carpal Ganglion Clinical Evaluation
- May cause chronic wrist pain or be asymptomatic
- May have limited range of motion, dorsal or volar pain, decreased strength
Intraosseous Carpal Ganglion Xray / Diagnositc Tests
- Wrist X-rays eccentrically placed radiolucent lesion with a thin sclerotic margin contained within, and not expanding the affect carpal bone.
- MRI demonstrates intermediate signal intensity on T1-weighted images and high-signal intensity on T2-weighted images (Feldman F, Skeletal Radiol. 1989; 18(5):353-358).
Intraosseous Carpal Ganglion Classification / Treatment
- Conservative: nsaids, activity modifications, splint. Repeat plain radiographs
- Surgery: complete curettage of the cyst with autogenous bone graft. 25135
- Consider arthroscopically assisted debridement and grafting of the lunate intraosseous ganglion. (Bain GI, Turner PC, Ashwood N. Arthroscopically assisted treatment of intraosseous ganglions of the lunate. Tech Hand Up Extrem Surg. 2008; 12(4):202-207.)
Intraosseous Carpal Ganglion Associated Injuries / Differential Diagnosis
- unicameral bone cyst
- degenerative cyst
- fibrous developmental defect
Intraosseous Carpal Ganglion Complications
- Carpal instability
Intraosseous Carpal Ganglion Follow-up Care
Intraosseous Carpal Ganglion Review References
- Tham S, Ireland DC. Intraosseous ganglion cyst of the lunate: diagnosis and management. J Hand Surg Br. 1992; 17(4):429-432.
- Schrank C, Meirer R, Stäbler A, Nerlich A, Reiser M, Putz R. Morphology and topography of intraosseous ganglion cysts in the carpus: an anatomic, histopathologic, and magnetic resonance imaging correlation study. J Hand Surg Am. 2003; 28(1):52-61.
- Mogan JV, Newberg AH, Davis PH. Intraosseous ganglion of the lunate. J Hand Surg Am. 1981; 6(1):61-63.
- Pablos JM, Valdés JC, Gavilán F. Bilateral lunate intraosseous ganglia. Skeletal Radiol. 1998; 27(12):708-710.
- Waizenegger M. Intraosseous ganglia of carpal bones. J Hand Surg Br. 1993; 18(3):350-355.
- Barth E, Hagen R. Juxta-articular bone cyst. Acta Orthop Scand. 1982; 53(2):215-217.