SL Tear or Ganglion Cyst?

[manny6]

About 2 months ago I developed severe wrist pain after stressing it significantly by biking, push-ups and rock-climbing. I had to stop in the middle of a climb as my wrist would not bend and it hurt a lot when I tried to push up on some rock with my palm facing down.
I went to a hand surgeon about 2 weeks later (pain and mobility got worse since last rock climb and this was obviously not just a simple sprain), who took some x-rays and examined my hand. My wrist hurt severely when bent downward all the way and upward all the way. The doctor found a small ganglion cyst protruding from the knuckle side of my wrist when the wrist was bent all the way down. He also observed that there was a little bit of spacing between the scaphoid and lunate bones. So he had a splint put on me and ordered an MRI.
Had the MRI a few days later. The MRI found a small dorsal ganglion cyst with possible synovitis, and said that the SL ligament was intact.
I saw the doctor again about 6 weeks later. His fellow doctors told me that it was just a ganglion cyst, and they would send me to therapy and I should probably be fine in a month or so. However, the main doctor then met me, looked at the MRI results and somewhat disregarded it saying that the previous x-ray had shown an SL tear and the MRI results were not reliable. He wanted to take a conservative approach and has sent me to physical therapy for 6 weeks which starts in a few days. My wrist was not physically examined, although I mentioned I didn't have pain as I had not been using my wrist, and that it was now stiff from lack of movement. He cancelled the diagnosis that read ganglion cyst and replaced it with SL tear.
I have had my wrist in the splint for about 7 weeks now. When I take it off, it feels stiff and when I try to bend it upward it does not hurt and bending down hurts a bit when I try to go down all the way, BUT its still very stiff and I'm afraid of pushing it too far.
Any clues, as to what may be wrong with me and what are my possible options?

[manny6]

I have no pain at this point. I had therapy for 4 weeks and its been a month since then. In therapy my wrist was stiff and slightly painful but that was probably to do with being in a splint for 2 months. I quickly regained strength and lost the pain and stiffness. Basically my hand surgeon was either too cautious or a dishonest. There is no doubt in my mind that funds flow both ways between the doctor's office and the PT. And he is a world famous surgeon! It's obvious my ligament was never torn and I have a ganglion cyst. I got a second opinion from another less famous but equally competent hand surgeon, and was told that the MRI was of a very high quality and the x-ray was of a very poor quality. The MRI clearly shows a ganglion cyst while the x-ray shows nothing in particular. This incident has only increased my distrust in the medical system and doctors watching out for either their own pockets or stroking their egos.

[JennyB00]

I am thinking that maybe it could be a ligament tear since often it is hard to tell from an X-ray, especially if the injury has just occurred. But I am assuming that this was why they had you do an MRI, but you must remember that these aren't always accurate either. I was told about 3 weeks ago that I just had a ganglion cyst develop after an unfortunate fall and not to worry about anything,  but today I went to an orthopedic surgeon since the pain was definitely still there and he informed me that I actually have an SL tear which will require surgery. It was evident from my X-ray that there was a gap between two of my bones, but I was told that it takes time for the gap to develop and become visible so maybe if your pain is persistent and does not go away, you could ask for them to do a follow up x-ray some time from now and see if there is still no sign of a ligament tear. Not knowing what is wrong is definitely a terrible feeling!! :(

[manny6]

Thank you for your reply. I have been in physical therapy for about a week now and I am gaining back a good bit of range of motion, strength, etc. However I still have what I would best describe as a dull aching pain in my wrist. I had another doctor look at my MRI, and he said it was surely an occult dorsal ganglion cyst that was cause of my pain and that my SL ligament seems fine. Will physical therapy actually help me or hurt me? If I am feeling pain at this stage (2 months of being in a splint, followed by therapy) is it more likely I have a ganglion cyst or a ligament tear?

[S. Kaul, MD]

Hi there!

Well, this would be a difficult situation to comment on, without knowing the relevant clinical details or having had a look at the imaging studies. However, there should be no harm done in trying to treat this as a scapho-lunate ligament tear, since the approach is conservative. The stiffness is likely to be a result of splintage and should improve overtime with appropriate physiotherapy.
Hope this is helpful.

Take care!