Joe A Shaw PA-C - 10/11/2008

Question
Dear Dr. Shaw
My name is Dr. Radenka Maric. I am originally trained as a MD, completed my PhD in engineering, and now I am working as a scientist for a National Research Council of Canada in Vancouver.

In December of 2004 I was involved in a motor vehicle accident (MVA). My vehicle was rear-ended while stopped at a traffic light. Both wrists hyperextended when they plunged down on the inner aspect of the steering wheel and I therefore suffered hyperextension type injuries. I noted onset pain in my wrist bilaterally that has become ongoing, with weakness and 揵umps?on both extensor aspects. My doctor suggested to wear a wrist splints for both wrists round-the clock. I have a pain when working on computer and sometimes hard time to dress myself.

A MRI has confirmed that the lesions on left wrist and right wrist are ganglions. The left wrist ganglion were excised in 2007.  Unfortunately, my symptoms failed to improve. I am still in pain. My physician arranged for another MRI of both wrists.  The MRI confirmed that I have bilateral proximal carpal row cysts and that these are suggestive of ganglia for both wrists. Additionally small dorsal and volar soft tissue ganglia were identified involving the left wrist.

My health is otherwise unremarkable. I am currently unmedicated and without drug allergies.

My physician is willing to refer me to any doctor.

I would like if you can provide me with your opinion

Can the trauma in my wrist during (MVA) result in ganglion and cyst development? I read paper from Weiss Orthopaedic, Dr. Noah Weiss and he is saying that history of trauma, such as fall, or a direct blow can cause ganglion or cyst development.
Your recommendation for operative repair or therapy;
Your prognosis;
Is it possible that you can see me and treat me?




I look forward to hearing from you.

Best regards,
Dr. Radenka Maric  

Answer
Dr. Maric,
Yes I think it is generally accepted in the U.S anyways that wrist trauma such as dorsiflexion MAY cause or increase your risk of getting a ganglion cyst, esp if the history fits..ie 45 y.o w NO ganglion cyst hx, had a MVA involving wrist trauma, now a month or two later a ganglion pops up.
As you may know the ganglion is like a mushroom with roots..you can excise the head of the mushroom, but some people have these "roots" that still extend into the joint capsule and may give rise to another "cyst"
I would want to know for sure it is ganglion cysts, so a 2nd opinion from a ortho hand surgeon would be in order. (I also have included a reliable article talking about different types of tumors/lesions in the hands/wrists that you may find informative)

I would be reluctant to again try surgery if you say that you had surgery on left and your symptoms failed to improve. Maybe you could try a couple of rounds of cortisone injections first and give it a couple of months. It seems that patients you have had them a while dont have pain w them after a while, unless they are wrapped around nerves or the like.
I am with an on-site medical company and only see contracted employees.
I think you are doing a good job in covering all your bases though.

http://knol.google.com/k/e-gene-deune/ganglion-cysts/ubX-XtFU2/713z31?locale=en#