7. How is the diagnose steps from the scenario ?

Anamnesis
Anamnesa is always preceded by taking the complete identity of the patient, such as
name, date of birth, age, sex, address, occupation etc, then followed by the main
complaint and then the new history of the disease now complained, then the history of the
disease first, and family history and health history.

Anamnesis Clinical Symptoms of the scenario

Identity of the patient
A woman, 35 years old, and for the Date of
o Patient’s name ?
birthday and Address of patients on the address
o Date of birth of Patient’s ?
scenario and the patient's birth date is not
o What is the patient's age ?
attached
o Where the patient's address ?
Compalaint
Location She come to community health centers with
o Where do you feel it ? bumps on back of the left hand.
Quality She feel like the left hand sometimes there is
o What does it feel like ? numbness on left fingers
Quantity or severity
o How much pain is felt (if pain
Scenario is not explain about the felt of pain
asks to give a scale of 1-10)

Time Since 1 yaers ago. The bumps felt bigger but

o When started of the pain?, How the size is vary, sometimes there is numbness
long does the complaint last ? on left fingers.
Circumstances that trigger a complaint,
including environmental factors, personal
activity, emotional reactions, or other -
circumstances related to disease complaints

Other factors that relieve and aggravate the

symptoms
The scenario does not explain anything else
o Is there anything else that eases
that eases or aggravates complaints
or aggravates complaints?

Other symptoms that accompany the main

complaint,
Sometimes there is numbness on left fingers.
o Do you feel any other
complaints that accompany ?
 Physical examination
o General
Performed measurements of vital signs, such as blood pressure, breath frequency,
pulse, body temperature, etc.
o Local
Performed inspection (look), palpation (feel), movement (move).

Allen’s Test
On a physical examination there is a soft, tender lump that can not be moved, nor is there any
discoloration on the skin above the allen examination cyst should be performed when the cyst is
near the radial and ulna arteries to assess collateral blood flow from the radial and ulnar arteries
(Medscape, 2015).

Transiluminasi Test
Through transilumination it is known that the contents of the lumps are not a solid mass but are
fluid. In aspiration obtained liquid with a high viscosity and clear (Hochwald & Green, 2002).
Supporting investigation
o For wrist lesions, posteroanterior (PA) standard radiology, lateral and oblique are
used.
Small ganglion cysts (<10 mm) often appear hypoechoic without posterior
acoustic imaging, do not appear as simple cysts. Larger ganglion cysts are more
likely to appear anechoic with a posterior acoustic enhancement.
o MRI or ultrasound can be used when the diagnosis is unclear.

USG of ganglion kista

o The mucus cyst is evaluated by standard PA, lateral and oblique obstetric
radiographs of the affected fingers.
o In radiology, the interosseous ganglion may be in a central location or side of the
affected bone. Radiology can also describe the juxtaosseous ganglion that
penetrates the bone. The lesion is radiolucent with a sclerotic border. These
ganglion often occur near the joint surface.
o MRI is used to view ganglion that is not seen with conventional radiology.
o Axial, Coronal, or Sagital CT-Scan is used to view ganglion cysts that are vague.
o Bone Scan is used to determine whether an intraosseous period is metabolically
active and causes pain.
o Microscopic picture
Researchers used an electron microscope to show cystic images microscopically.
The results showed that the ganglion cyst wall consisted of collagen fiber sheets
arranged in multi-way strata. The walls consisted of flat cells resembling
fibroblasts, but with clearly visible epithelial or synovial layers. Most fluid-filled
cysts are very thick like jelly, significantly thicker than synovial fluids. This
viscosity is due to the high concentrations of hyaluronic acid and other
mucopolysaccharides (Dandy & Dennis, 2003).

Microscopic picture of ganglion cyst

1. Emedicine health (http://www.emedicinehealth.com/ganglion_cyst/article_em.htm)
2. Hochwald, N.L & Green, S.M in Tumors, Spivak Jeffrey M ed. et al in Orthopaedics A Study
Guide. New York : McGraw-Hill. 2002.