Reevaluation of the cause of the wrist ganglion.

The cause of the wrist ganglion is uncertain. We reviewed our experience with rotary subluxation of the scaphoid after ganglion excision. Seventeen patients had triscaphe arthrodesis for treatment of rotary subluxation of the scaphoid at an average of 35 months (range, 6 to 130 months) after ganglion excision. In addition, dynamic or static rotary subluxation of the scaphoid was found in 8 of 10 patients who were examined at an average of 16 years (range, 11 to 19 years) after excision of a ganglion. These patients had no symptoms at the time of review. Only single case reports of rotary subluxation of the scaphoid after ganglion excision have been previously reported. We believe our data supports a hypothesis that the ganglion is a secondary manifestation of underlying periscaphoid ligamentous injury. Persistent symptoms after ganglion excision should lead one to suspect underlying scaphoid instability.