Ultrasound-Guided Aspiration and Dextrose Prolotherapy for a Triangular Fibrocartilage Complex Ganglion Cyst in an Avid Golfer: A Case Report

Yonghyun Yoon, Stephen Cavallino, Teinny Suryadi, Anwar Suhaimi, Jonghyeok Lee, King Hei Stanley Lam

Cureus 18(1): e101874

Abstract

The triangular fibrocartilage complex (TFCC) is a key stabilizer of the ulnar side of the wrist, and ganglion cysts arising primarily from the TFCC are uncommon, with no clear consensus on optimal management.

We report the case of a 63-year-old right-handed male businessman and avid golfer, whose work required regular business golf rounds, presenting with several months of persistent left ulnar-sided wrist pain that worsened during golf swings when not using a brace. Physical examination revealed a positive ulnar fovea sign and pain with grip strength testing. Radiographs demonstrated neutral ulnar variance, and computed tomography showed no evidence of fracture or significant arthritic changes. Ultrasonography identified a multiseptated ganglion cyst adjacent to the TFCC. Under ultrasound guidance, the cyst was aspirated, followed by prolotherapy using 10% dextrose injected into the TFCC enthesis. The patient subsequently underwent a structured rehabilitation program including physical therapy and isometric exercises. After five sessions of prolotherapy at two-week intervals, his pain resolved completely, and he was able to maintain his work-related golf schedule without discomfort.

This case suggests that ganglion cysts may occur secondary to TFCC pathology and underscores the value of ultrasound not only for diagnosis but also for guiding minimally invasive interventions. Ultrasound-guided aspiration combined with prolotherapy may represent an effective, joint-preserving treatment option for TFCC-associated ganglion cysts, potentially avoiding the need for more invasive surgical procedures in selected patients.

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