I have spent the better part of the past 5 years trying to determine the cause of my wrist pain. I have now found an orthopedic surgeon who has identified a large cyst in the scaphoid bone.
To summarize my symptoms: I have had a loss in dexterity and strength. I have full range of motion, but cannot move my fingers as quickly as normal. If i hold anything for a short length of time or isolate movements in my fingers, I feel extreme pain in the anterior wrist, in the middle of the wrist. If I experience any shock or mild bump on my arm or hand, I feel extreme pain in the wrist that will last for approximately two weeks - what I would imagine it would feel like if I had broken my wrist. Symptoms are daily.
My Orthopedic is not positive that the cyst is the cause of my issues, but it is the only thing abnormal in my wrist. There is no evidence of a previous injury, scar tissue, tendinitis, or carpel tunnel. He is recommending surgery to extract the cyst and re-strengthen the bone with an extraction from the radius.
Has anyone had experience with this type of condition or procedure and have any words of advice or words on what to expect with the recovery?
There isn't a lot of information available for this type of condition, so anything would be valuable!
There are several conditions which can cause cystic structures within the scaphoid. These include: an intraosseous ganglion cyst, a simple cyst, a cyst from an inflammatory process like rheumatoid arthritis, and a tumor.
If it is an intraosseous ganglion, then removing it may help with your discomfort.
A small, simple, bone cyst, which just sometimes occur, may be helped by bone grafting, if the cyst was causing structural weakness in the bone.
In inflammatory processes, treating the cyst, might help any problems created by the cyst. But, removing the cyst would not cure the underlying inflammatory process, or treat any problems stemming from that process.
Tumors, which cause cysts, are rare in the hand/wrist. And those that do occur, are usually benign. Treatment of these cysts, will usually help with the discomfort.
So, it depends largely on the underlying pathology.
Also, operating on the wrist, can cause some decreased range of motion in some patients. Removing the cyst and bone grafting it, while not a huge operation, it is not just a simple wart removal either.
Speak with your surgeon, as to what he/she thinks this is and what the expected outcome of the surgery would be. Good luck. Hope you find out the cause and get it treated.
Thank you so much Gaelic for responding. Your description of the posible types of cysts really filled in the gaps in research I have done and has helped me formulate what questions to ask my orthopedic surgeon.
The type or cause of the cyst has not been determined apart from that it's not due to arthritis nor is there any surrounding inflammation.
As for bone grafting surgery, do you have any thoughts on whether there may be decrease mobility in the fingers post-recovery? I currently have limited speed in my "bad hand" and am concerned I might be further limited post-recovery.
Also, any thoughts on "full" recovery time? I had ACL surgery 18 months ago, so am well aware that there are many stages for recovery. So full recovery to me means recovered to the point where it is no longer limiting.
The deceased range of motion should be limited to the wrist, if it occurs. Like stated, some patients get significant scarring of the capsule and tissues under the skin, and this can lead to not regaining full ROM, especially at the extremes.
The motion of the fingers should not be affected, unless,...you develop adhesions within the extensor tendon sheaths. Then, of course, you could get decreased ROM. But, usually that can be avoided by being sure to move the fingers right after surgery.
You have been through a major orthopedic surgery, so you know how important it is to start ROM immediately after surgery.
The bone graft is harvested through the same incision, usually on the dorsal (back) aspect of the wrist. It is taken from the distal radius, and just a small amount is needed. So, the surgeon just slips under the muscles, makes a small hole in the cortex (hard outer bone) and scoops out a little of the cancellous (spongy) bone along with a tiny bit of bone marrow. This is then packed into the cyst, after it has been cleaned out. The idea being, that the cancellous bone will both fill in the defect as well as bring in cells to generated new bone.
As to recovery, this is a significant surgery, but not a huge one. Nothing is cut, moved, repaired, reconstructed, etc, so that it would have to be really protected after surgery. It is basically just getting over the trauma of the surgery.
Usually after this type of surgery, the wrist is held still for a week to 10 days for comfort, but the fingers can be moved immediately. Then the wrist is allowed to move to tolerance. You can gradually move and strengthen the wrist and hand.
It takes about 6 weeks usually for the graft to incorporate into the bone, but since this is not for a scaphoid fracture, if it takes longer, that's okay. The scaphoid is still in continuity, so there isn't anything to "protect".
The fact that you do not have any inflammation around the cyst, is good. That usually rules out a tumor or inflammatory conditions. So, it is most likely an intraosseous ganglion or a simple cyst.
You can probably find things on the internet about an intraosseous ganglion. But, basically, it's a ganglion cyst, that has decided to grow into the bone, instead of outward, away from the joint. As it grows, it puts pressure on the bone, gradually pushing the bone out of the way. The theory why they hurt, is the pressure they exert on the bone.
Simple bone cysts usually don't hurt, unless they weaken the bone.
So, depending upon how you do, most patients get back to light activities within 10 days or so. Weight bearing activities (pushups, pull ups, heavy lifting) will take a bit longer, of course. So, if you have a sedentary type job, two weeks and you should be doing most things. But, if you are a manual laborer, then it may be 6 weeks or so before you feel comfortable. You've gone through the ACL rehab, so you sort of know your body and how much you can push things.
Talk to your surgeon for specifics on his/her rehab protocol.