A 25-year-old woman has a painless, fluctuant swelling over the volar aspect of the wrist present for 6 months. On compressing one part of the swelling, the other component becomes tense, indicating communication across the wrist. She has no fever or constitutional symptoms. What is the most likely diagnosis?

• A Rheumatoid nodule of the wrist
• B Pyogenic flexor tenosynovitis
• C Giant cell tumour of the distal radius
• D Compound palmar ganglion ✓

Explanation

Compound palmar ganglion is chronic tuberculous tenosynovitis of the flexor tendon sheaths. The sheath dilates proximal and distal to the flexor retinaculum, producing an hourglass swelling that shows cross-fluctuation when squeezed, exactly as described. It is usually painless and may be accompanied by crepitus from melon seed bodies. Pyogenic tenosynovitis is acute, exquisitely painful and would not persist indolently for months, which excludes option B.

Reference: Tuli's Tuberculosis of the Skeletal System, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.