Kienböck’s Disease Hidden behind the Ganglion Cyst: A Clinical Clue

Abstract

Ganglion cyst is the most common soft tissue mass of the wrist. Diagnosis is made by physical examination. Ultrasonography is used for diagnosis of occult ganglions. Cosmetic appearence and annoying pain are the most common complains of the patient with a wrist ganglion. It is a benign lesion and most of the time it regresses spontaneously or is treated with simple strategies. On the other hand, dorsal wrist ganglions could be misleading in diagnosis of underlying more serious pathologies. Traumatic bone or ligament injuries, benign bone tumours, inflammatory arthropathies, ulnar impaction syndrome, Kienböck’s disease and many other pathologies may have the similar symptoms with the wrist ganglion. Physicians should be suspicious in case of debilitating progressive symptoms. Ultrasonography is not diagnostic for most of the possible underlying diseases so further evaluation should be done with radiography and Magnetic Resonance Imaging (MRI). We report a case of 21-year-old man with severe right wrist pain and dorsal wrist ganglion, diagnosed with Kienböck’s disease seven months after the beginning of symptoms.

Keywords

• avascular necrosis
• delayed diagnosis
• lunate pathology
• wrist pathology