You are on page 1of 29

DORSAL GANGLION CYST : MRI Study

Jerome Garret & Bertrand Bordet

Clinique du Parc de Lyon

Purpose of the study

MRI focus of the origin of the dorsal ganglion cyst of the wrist
DRC – DIC – SLIOL - DCSS
DRC

SLL

Elucidate the enigmatic physipathology of the dorsal ganglion cyst
DIC distal

DIC proximal

Anatomy

SLIOL  
DRC  
DIC  

3D MRI DP FS MPR coronal oblique

DRC  

3D MRI DP FS MPR

DIC  

3D MRI DPFS MPR

SLIOL  (dorsal  part)  

3D MRI DP FS sagittal view

DIC  
SLIOL  (dorsal  part)  
DRC  

3D MRI DP FS sagittal view

Mediocarpal  joint  

Radiocarpal  joint  

What’ s new ?

DCSS [Arthroscopic Staging of Scapholunate Instability after DCSS
Sectioning - Luc Van Overstraeten & Christophe Mathoulin J Wrist Surgery 2013; 2:149-154]

Dorsal Capsulo-Scapholunate Septum

Anatomical structure wich come from
the radial articular crest
to the wrist wich twin attachments
in the dorsal part
of the lunate & SLIOL & scaphoïd

Courtesy Luc Van Overstraeten

Dorsal Capsulo-Scapholunate Septum

Université Libre de Bruxelles
Faculté de Médecine
Le complexe scapho-lunaire, un nouveau concept !
Un autre regard sur l’instabilité du carpe

Luc Van Overstraeten
Manuscrit soumis en vue de l’obtention du titre de
Docteur en Sciences Médicales
de l’Université Libre de Bruxelles
Année 2014-2015
Promoteur : Professeur Frédéric Schuind
Service d’Orthopédie-Traumatologie
Cliniques Universitaires de Bruxelles, hôpital Erasme
808 route de Lennik
B-1070 Bruxelles
Tél : +3225553111

Intra articular ligament
& Extra synovial

3D  MRI  DP  FS  sagi=al  view  

DIC  
SLIOL  
DRC  

DCSS

Methods
We realized 14 MRI on patients with a wrist dorsal cyst
The protocol of exploration included standard sequences
balanced in density of proton with fat suppression
technique in the three planes but also 3D T2-weighted
isotropic inframillimetric sequences with fat suppression
allowing a MPR analysis (MultiPlanar Reconstruction) of
the cyst and his origin.

Results
The origin of the cyst was always the same
Intra ligamentous in the SLIOL/DCSS
Small pedicle between the DIC distal & DRC proximal

Case 1 3D MRI DPFS MPR

Ganglion cyst    

Case 1 3D MRI DPFS MPR

Ganglion cyst ‘s origin

Case 1 3D MRI DPFS MPR

Volumic  reconstrucCon  

CASE 2

Ganglion cyst

CASE 2

Ganglion cyst ‘s origin

CASE 2

CASE 3

Ganglion  cyst  ‘s  origin    

CASE 3 3D MRI DPFS SAGITTAL MPR

Discussion
Does these study can help to elucidate the pathogenesis
of the dorsal wrist ganglion?
What do you know?
1- Ganglion cyst don’ t have an inflammatory aetiology
Pathologic studies showing no pericystic inflammatory changes

2- Ganglion cyst is not a simple herniation of the joint
capsule
The liquid in the cyst is different of the synovial liquid.
Cyst liquid = hyaluronic acid

3. Some ganglion cyst communicates with the joint
Angelides demonstrated movement of intra articular constrat from the
radio carpal joint into ganglia in 44% of patients with dorsal wrist
ganglion

4-  Mucoid degeneration of the capsule.
« Ganglion of the wrist : proposals for topographical
systematization and natural history.” Kulhmann JN & al . Rev Chir
Orthop Réparatrice Appar Mot 2003; 89: 310-9.

5- Non healing of the ACL tear
« Histogical changes in the human anterior cruciate ligament after rupture »

Murray MM, Martin TL, Specter M. J Bone Loint Surg Am 2000; 82: 1387-1397
« Post injury changes in the properties of mesenchymal stem cells
derived from human anterior cruciate ligaments. »
Nohmi S & al Int Orthop. 2012 Jul.

Deregulation of the extra cellular matrix of the ligament by the
synovial liquid

IL & TNF alpha of the synovial liquid trap the hyaluronic acid of the
matrix and deregule the extra cellular matrix.

Mesenchymal cells of the ligament secrete a abnormal quantity of
proteoglycan agregat = micro cysts of hyaluronic acid.

6- MRI study found always the same origin of the ganglion cyst in
the DCSS ligament intra articular & extra synovial
DIC

cyst

Capitate
Lunate

DCSS

Radius
DRC

We support the « Capsular rent theory »

« Capsular rent » theory:
Joint stress may lend to a rent in the capsule and allow leakage of synovial
fluid into the intra articular ligament.

Reaction between this fluid and local tissue results in the creation of the
gelatinous cystic fluid and the formation of the cyst wall.

A partial tear of the deep part of the capsule
allow the penetration of the synovial liquid into the
capsule responsable of the mucoid degeneration at
the origin of the cyst.

Thank you
j.garret@cliniqueduparclyon.com