A 38-year-old labourer presents with a six month history of a bilobed, doughy swelling on the volar aspect of his right wrist, extending both proximal and distal to the flexor retinaculum. It is cross fluctuant, non tender, and he reports occasional tingling in the thumb, index and middle fingers. Systemic examination is unremarkable. What is the most likely diagnosis?

• A Rheumatoid nodule over tendon sheaths
• B Simple ganglion of the wrist
• C Soft tissue sarcoma of the forearm
• D Tuberculous tenosynovitis of the flexor sheaths (compound palmar ganglion) ✓

Explanation

Compound palmar ganglion is tuberculous tenosynovitis of the common flexor sheath. It characteristically forms a dumbbell shaped swelling with one lobe in the palm and another deep to the flexor retinaculum in the distal forearm, allowing cross fluctuation between the lobes, and it may compress the median nerve in the carpal tunnel. A simple ganglion is unilocular and never crosses the retinaculum, which excludes option B.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.