Tests
1st tests to order
no initial test
Test
Result
clinical diagnosis
Tests to consider
cyst aspiration
Test
Aspiration of dorsal ganglion cysts will yield a thick, jelly-like, clear fluid.
If there are any concerns regarding infection or inflammatory arthropathy, the fluid obtained should be sent for microscopy for white blood cells and crystals.
Aspiration of volar ganglion cysts is not recommended due to the potential risk of injury to the radial artery.[22]
Result
thick, clear, jelly-like, fluid
erythrocyte sedimentation rate
Test
May be elevated if mass is secondary to an infectious process.
Result
normal
C-reactive protein
Test
May be elevated if mass is secondary to an infectious process.
Result
normal
complete blood count
Test
White cell count may be elevated if mass is secondary to an infectious process.
Result
normal
wrist x-ray
Test
Typically, radiographs are normal. However, in some cases, evidence of healed fractures or scapholunate injuries may be apparent. Scapholunate injuries appear as widening greater than 3 mm on the posteroanterior radiograph or dorsally angulated lunate on the lateral radiograph.
Degenerative changes (sclerosis and decreased joint space) may be present if mass is secondary to osteoarthritic changes.
Result
normal
ultrasound
magnetic resonance imaging
Test
Performed when the probability of other wrist pathology remains high.
Delineates size and physical characteristics of ganglion cysts.[17][18][23]
May show volar ganglion communication with the radial artery.
Can determine the involvement of any flexor or extensor tendons.
Can detect ligamentous injuries (e.g., scapholunate ligament tears).
MRI has sensitivity of 83%, specificity of 50%, positive predictive value of 94%, and accuracy of 80% for occult ganglion cysts.[21]
Result
fluid-filled cyst
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