Ganglion Kisti ve Karpal Bossun Ayırıcı Tanısında Klinik ve Radyolojik Belirteçler

Öz

Amaç: Dorsal el bileği kitleleri, el bileği ağrısının sık görülen nedenlerinden olup en yaygın olarak ganglion kistleri (GK) ve karpal boss (KB) ile temsil edilir ve klinik olarak ayırt edilmeleri güç olabilir. Bu çalışmanın amacı, GK veya KB tanısı alan hastaların demografik, klinik ve radyolojik özelliklerini karşılaştırmak; ayırıcı tanıda yararlı parametreleri belirlemek ve semptomatik dorsal el bileği kitleleri arasında KB’nin göreceli oranını ortaya koymaktır.

Gereç ve Yöntemler: 2021-2025 yılları arasında el bileği ağrısı ile başvuran ve manyetik rezonans görüntüleme ile GK (n=1058) veya KB (n=114) tanısı alan 18-65 yaş arası hastalar retrospektif olarak analiz edildi. Demografik veriler, lezyon özellikleri, görsel analog skala (VAS) ile değerlendirilen ağrı düzeyi, el bileği eklem hareket açıklığı (ROM), kitle lokalizasyonu, eşlik eden radyolojik bulgular, uygulanan tedavi yöntemleri, nüks oranları ve Disabilities of the Arm, Shoulder and Hand (DASH) skoru kaydedildi.

Bulgular: Ortalama yaş GK grubunda anlamlı olarak daha düşüktü (35,2±10,5’e karşı 48,7±12,3 yıl; p<0,001). Ağrı düzeyi GK grubunda anlamlı derecede daha düşüktü (p=0,01). GK’ler en sık skafo-lunat aralıkta lokalize iken, KB olguları ağırlıklı olarak ikinci ve üçüncü karpometakarpal eklemler düzeyinde saptandı (p<0,001). KB, daha belirgin eklem hareket açıklığı kısıtlılığına ve eşlik eden osteoartritik değişikliklere yol açmaktaydı (p<0,001). Lojistik regresyon analizinde yaş, kitle lokalizasyonu ve ROM’un bağımsız prediktörler olduğu gösterildi. Nüks oranları GK grubunda anlamlı derecede daha yüksekti (p<0,001).

Sonuç: Karpal bossun, semptomatik dorsal el bileği kitleleri arasında daha önce beklenenden daha yüksek bir orana sahip olduğu saptanmıştır. Bu nedenle, özellikle ganglion kisti şüphesi bulunan hastaların değerlendirilmesinde yaş, kitle lokalizasyonu ve eklem hareket açıklığı ayırıcı tanıda dikkatle ele alınmalıdır.

Anahtar Kelimeler

• Ganglion Kisti
• Karpal Boss
• El Bileği Ağrısı
• Ayırıcı Tanı
• Klinik Değerlendirme
• Radyolojik Değerlendirme

Etik Beyan

Etik kurul onayı, Bilecik Şeyh Edebali Üniversitesi Tıp Fakültesi Etik Kurulu’ndan alınmıştır (Karar No: 381563, Tarih: 06.01.2026).

Teşekkür

hastaların değerlendirilmesinde yaptıkları katkılardan dolayı Utkan Sobay, M.D. ve Erkam Çeker M.D.'ye teşekkür ederiz.

CLINICAL AND RADIOLOGICAL MARKERS IN THE DIFFERENTIAL DIAGNOSIS OF GANGLION CYSTS AND CARPAL BOSS

Öz

Objective: Dorsal wrist masses are a common cause of wrist pain, most frequently represented by ganglion cysts (GC) and carpal boss (CB), and may be difficult to differentiate clinically. This study aimed to compare the demographic, clinical, and radiological characteristics of patients with GC or CB, to identify parameters useful for differential diagnosis, and to determine the relative proportion of CB among symptomatic dorsal wrist masses.
Material and Methods: A retrospective analysis was performed on patients aged 18-65 years who presented with wrist pain and were diagnosed with either GC (n=1058) or CB (n=114) on magnetic resonance imaging between 2021 and 2025. Demographic data, lesion characteristics, visual analogue scale (VAS), wrist range of motion (ROM), mass localization, concomitant radiological findings, treatment methods, recurrence rates, and the Disabilities of the Arm Shoulder and Hand (DASH) score were recorded.
Results: The mean age was significantly lower in the GC group (35.2±10.5 vs. 48.7±12.3 years; p<0.001). Pain was significantly lower in the GC group (p=0.01). GC were most commonly located at the scapholunate interval, and CB were predominantly identified at the second and third carpometacarpal joints (p<0.001). CB caused more restricted ROM and concomitant osteoarthritic changes (p<0.001). Logistic regression analysis showed that age, mass localization, and ROM were independent predictors. Recurrence rates were significantly higher in the GC group (p<0.001).
Conclusion: CB constituted a higher proportion of symptomatic dorsal wrist masses than previously expected. Age, mass localization, and ROM should therefore be carefully considered in the differential diagnosis of dorsal wrist masses, particularly when evaluating suspected GC.

Anahtar Kelimeler

• Ganglion Cyst
• Carpal Boss
• Wrist Pain
• Differential Diagnosis
• Clinical Evaluation
• Radiological Evaluation

Etik Beyan

Ethic committee approval was obtained from the Bilecik Seyh Edebali University School of Medicine Ethics Committee (Decision No: 381563, Date: 06.01.2026).

Teşekkür

We thank Utkan Sobay, M.D., and Erkam Çeker, M.D., for their contributions to the evaluation of the patients.

Kaynakça

1. 1. Moellhoff N, Throner V, Frank K, Benne A, Adelmann S, Coenen M et al. Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps. Arch Orthop Trauma Surg. 2023;143(2):1095-102.
2. 2. Poh F. Carpal boss in chronic wrist pain and its association with partial osseous coalition and osteoarthritis-a case report with focus on MRI findings. Indian J Radiol Imaging. Thieme Medical and Scientific Publishers Private Ltd.; 2015;25(03):276-9.
3. 3. Goller SS, Kajdi GW, Feuerriegel GC, Sutter R. Radiopalmar ganglion cysts: prevalence, morphology, and clinical significance in wrist MRI. Eur Radiol. Springer; 2024;34(12):7869-77.
4. 4. Bo Eissa AN, Almulhum AK, Alsaeed MN, Buanq AA. A rare case of carpal boss lesion with an overlying ganglion cyst: case report and literature review. J Surg Case Rep. 2024;2024(5):rjae287.
5. 5. Zanetti M, Saupe N, Nagy L. Role of MR imaging in chronic wrist pain. Eur Radiol. Springer; 2007;17(4):927-38.
6. 6. Mespreuve M, De Smet L, De Cuyper K, Waked K, Vanhoenacker F. MRI diagnosis of carpal boss and comparison with radiography. Acta Radiol. SAGE Publications Sage UK: London, England; 2017;58(10):1245-51.
7. 7. Goiney C, Porrino J, Richardson ML, Mulcahy H, Chew FS. Characterization and Epidemiology of the Carpal Boss Utilizing Computed Tomography. J Wrist Surg. 2017;6(1):22-32.
8. 8. Park MJ, Namdari S, Weiss A-P. The carpal boss: review of diagnosis and treatment. J Hand Surg. Elsevier; 2008;33(3):446-9.

9. 9. Porrino J, Maloney E, Chew FS. Current Concepts of the Carpal Boss: Pathophysiology, Symptoms, Clinical or Imaging Diagnosis, and Management. Curr Probl Diagn Radiol. 2015;44(5):462-8.
10. 10. Ton Y, Powell JE, Chowdhary K. Evaluation and Management of Dorsal Wrist Impingement Syndrome (DWIS). Curr Phys Med Rehabil Rep. Springer; 2025;13(1):23.
11. 11. Nevalainen MT, Roedl JB, Morrison WB, Zoga AC. MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries. Skeletal Radiol. Springer; 2019;48(7):1079-85.
12. 12. Ferreira Branco D, Botti P, Bouvet C, Abs B, Buzzi M, Beaulieu JY, et al. Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI. Eur Radiol. Springer; 2024;34(12):7856-63.
13. 13. Zeidenberg J, Aronowitz JG, Landy DC, Owens PW, Jose J. Ultrasound-guided aspiration of wrist ganglions: a follow-up survey of patient satisfaction and outcomes. Acta Radiol. SAGE Publications Sage UK: London, England; 2016;57(4):481-6.
14. 14. Kuliński S, Gutkowska O, Mizia S, Martynkiewicz J, Gosk J. Dorsal and volar wrist ganglions: The results of surgical treatment. Adv Clin Exp Med. Wroclaw Medical University; 2019;28(1):95-102.
15. 15. Kuliński S, Gutkowska O, Gosk J. Chemical Substances Used in the Treatment of Ganglions Located in the Hand and Wrist. Polim Med. 2016;46(1):95-100.
16. 16. Wong CR, Karpinski M, Hatchell AC, McRae MH, Murphy J, McRae MC. Immobilization of the wrist after dorsal wrist ganglion excision: a systematic review and survey of current practice. HAND. SAGE Publications Sage CA: Los Angeles, CA; 2023;18(2):254-63.
17. 17. Zheng T, Huang X, Yang Y, Li B, Li F, Li Z. Two-Year Clinical Outcomes after Arthroscopic Re-Excision of Recurrent Dorsal Wrist Ganglion Cyst. Orthop Surg. Wiley Online Library; 2023;15(2):480-7.
18. 18. Konigsberg MW, Tedesco LJ, Mueller JD, Ball JR, Wu CH, Kadiyala RK, et al. Recurrence rates of dorsal wrist ganglion cysts after arthroscopic versus open surgical excision: A retrospective comparison. Hand. SAGE Publications Sage CA: Los Angeles, CA; 2023;18(1):133-8.
19. 19. Clarke A, Wheen D, Visvanathan S, Herbert T, Conolly W. The symptomatic carpal boss: is simple excision enough? J Hand Surg Br Eur Vol. Elsevier; 1999;24(5):591-5.
20. 20. Roulet S, Bacle G, Marteau E, Laulan J. Surgical treatment of carpal boss by simple resection: results in 25 cases at a mean of 8 years’ follow-up. Hand Surg Rehabil. Elsevier; 2017;36(2):109-12.
21. 21. Wong AS, Jebson PJ, Murray PM, Trigg SD. The use of routine wrist radiography is not useful in the evaluation of patients with a ganglion cyst of the wrist. Hand. SAGE Publications Sage CA: Los Angeles, CA; 2007;2(3):117-9.
22. 22. Kuliński S, Gutkowska O, Mizia S, Gosk J. Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases. Adv Clin Exp Med. 2017;26(1):95-100.