Navicular cyst

Os scaphoideum - scaphoid bone enters the wrist structure as a bone in the front row, occupying the so-called radial position (lateral zone). The rear of the bone is a very thin band that extends to the wrist joint - the epiphysis of the radius, the palm zone joins the tuberculum ossis scaphoidei - the tubercle of the scaphoid bone. The lower lateral part of the scaphoid bone connects with the trapezoid bone. Such a multifaceted property to connect with different bone structures and the rather fragile structure of scaphoideum causes its vulnerability in the sense of mechanical injuries. The scaphoid cyst is often mistaken for fibrous neoplasms in this anatomical zone, especially in sports injuries, as well as in people who perform monotonous work with their hands. The bony cyst in principle develops asymptomatically, similarly to other benign tumor-like carpal formations, so differential diagnosis should become information that determines the path of neoplasm treatment.

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Symptoms of scaphoid cyst

Symptoms of the scaphoid cyst may be as follows: 

• Transient pain in the wrist after physical exertion.
• A slight swelling in the scaphoid bone.
• Without adequate treatment and immobilization of the wrist, the cyst can increase and manifest as a constant aching pain.
• An enlarged cyst can provoke a stress fracture with a small bruise or a wrist rest on the fall.
• Since the scaphoid bone is not equipped with a periosteum, a fracture may not be felt as a severe trauma and be perceived as an ordinary stretch. In such situations, refractive (repeated) fractures are possible, causing a visible deformation of the wrist.

Diagnosis of scaphoid cyst

The diagnosis of the bony cyst is confirmed by ultrasound, X-ray, computed tomography and biopsy.

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Treatment of scaphoid cyst

Treatment of a cystic tumor in the wrist is considered difficult, rather traumatic and accompanied by a risk of complications.

The tasks of cyst treatment in the scaphoid bone: 

• Decompression of the tumor, a gradual decrease in pathological intraosseous pressure.
• Neutralization of aggressive proteolysis and fibrinolysis.
• Fixation of the bone both in the diagnosed cyst and in a tumor burdened with a fracture.
• The procedures that help to activate bone tissue regeneration are compression (intraosseous pinning), stretching (distraction).
• Correction of the deformed wrist with the help of the device.

Small and timely detected scaphoid cysts are treated conservatively by multiple puncture and corticosteroids. However, this method is fraught with relapses, so after 1-2 months of monitoring the cyst, the patient is most often offered to remove the cyst by surgery. Exochlearation of the tumor and subsequent bone autoplasty and the appointment of drugs that promote the restoration of bone tissue. Qualitative osteosynthesis is possible with long-term intake of calcium preparations in combination with the intake of vitamin D (alfacalcidol). The process of implantation of a transplant depends on the characteristics of bone nutrition, the age of the patient. In children, such pathologies are treated more quickly and wrist functions are restored within six months. Patients over 45 years of age are treated for a long time, the probability of adequate fusion of the damaged scaphoid bone does not exceed 50%.