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For wrist lesions, standard posteroanterior (PA), lateral, and oblique views should be obtained. Mucous cysts should be evaluated with standard PA, lateral, and oblique plain radiographs of the involved digit. On radiographs, interosseous ganglions may be centrally or eccentrically located in the involved bone. Radiographs may also demonstrate a juxtaosseous ganglion that has penetrated the bone. The lesions are radiolucent with a sclerotic border. These ganglions usually occur near a joint surface.
Magnetic resonance imaging (MRI) or ultrasonography may be employed when the diagnosis is in question (eg, with occult ganglions).[12, 13, 14, 15] MRI reveals ganglions not seen on conventional radiographs. Axial, coronal, or sagittal computed tomography (CT) may be helpful in localizing occult ganglion cysts. Bone scans may help in determining if intraosseous masses are metabolically active and capable of causing pain.
The finger extension test is an important tool in the diagnosis of ganglions.
Fluid evacuated from ganglion cysts consists of mucin composed of glucosamine, albumin, globulin, and hyaluronic acid. Histologic sections of the cyst reveal compressed collagen fibers and a few flattened cells without evidence of epithelial or synovial lining. Multiple clefts may be present off the main cystic duct. No inflammatory or mitotic activity is seen.
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