A 22-year-old man presented with mild swelling, pain and tingling and numbness on the volar aspect of the wrist, ring and little finger. Radiography was non significant.
Ultra sonography suggested diffuse thickening of tendon sheath in flexor digitorum superficialis and flexor digitorum profundus from wrist base to whole palm region. Thickness measured was 6-9 mm. At wrist, 27x15x18 mm sheath thickening was found. Magnetic resonance imaging showed Ganglion cyst of the flexor tendons and well defined hour glass intensity area inside the ulnar aspect of carpal tunnel. Laboratory test results were normal, except for an elevated erythrocyte sedimentation rate (40 mm/h). EMG and NCV study of left upper limb was suggestive of median nerve compression at carpal tunnel. Surgical exploration of the lesion revealed rice bodies in the common flexor tendon synovial sheath, mainly in the third and fourth finger tendon sheaths, Removal of the rice bodies and thorough excision of the sheath was performed. No significant compression was found around median nerve. Patient was immobilized for 1 month with below elbow slab, started on Anti-Tuberculous Treatment and regularly followed up.
ganglion cyst, wrist, carpal tunnel