What happened to Miley’s wrist?

Friday, Miley Cyrus posted pictures of her wrist surgery on Instagram. Here’s the most likely story behind the graphic picture that’s all over the internet.

The most likely diagnosis

Miley most likely had a ganglion cyst. It’s the most common tumor of the hand and wrist – and it’s completely benign. In this picture of Miley dancing you can see a subtle lump on her left wrist. Apparently this was taken recently, just before the surgery. This is the exact spot where the cyst is typically located.   A cyst is a fluid filled tumor (a tumor just means “a swelling”). A ganglion cyst comes from a joint and is filled with a clear jelly. Here’s a video of a ganglion cyst being removed in surgery.

Do they hurt?

Most patients do not have much pain with these. However, they can cause some discomfort, especially with hyperextension of the wrist. In rare cases they can push on a nerve and cause numbness or tingling in the hand.

What causes them?

Ganglion cysts occur in people of all ages. Little kids all the way up to elderly people. In young people like Miley, they’re almost always caused by small microtears in the joint lining that let fluid escape from inside the joint. The fluid collects outside the joint and forms a cyst.

How are they treated?

Cysts can sometimes be ruptured with a needle in the doctor’s office. When the cyst is on the palm side of the wrist (like Miley’s), it is right next to the radial artery, the major source of blood flow into the hand. So it can be risky to put a needle into these cysts – the artery may be damaged. Sometimes it’s safer to just leave the cyst alone or remove it in surgery. Risks of taking out Miley’s cyst include: small risk of infection, damage to a small nerve next to the cyst, and damage to the radial artery. The cyst could also come back – there’s about a 5% chance of that.

What’s going on in the surgery picture?

In this picture we see Miley’s left hand, palm up on a blue background. That’s a surgical towel covering up the table where the surgeon works. The gloved hands are either the assistant’s hands or the surgeon’s hands. The circulating nurse is probably taking the picture by holding the camera above Miley’s wrist while the surgeon holds the retractors. The retractor on the left side is closest to the radial artery – it’s a blunt retractor, probably called a Senn rake. It has one blunt end and a sharp, rake-like end. You can see what the other end looks like on the right side of the picture. On the right side of the incision you can see something white – that’s a large tendon called the Flexor Carpi Radialis tendon. These cysts poke up right between the radial artery and the FCR tendon. If you want to Google other pictures of the type of cyst Miley had – just type in “volar ganglion cyst” into Google Images. The ink around the incision is used by the surgeon to mark where the incision should be. Sometimes the surgeon uses a smaller incision than where he marks. You can see the incision doesn’t go quite as far up toward the fingers as he’s marked on Miley’s wrist. You can also see the marking pen on the towel at the bottom of the picture. The smiley face is drawn on the cyst itself – I can’t tell if this was done later after the photo was taken or drawn by the surgeon on the actual cyst.

Why isn’t there any blood?

The surgeon uses a tourniquet to prevent blood from flowing into the surgical incision so he can see all the anatomy. This lowers the chance he’ll cut something he shouldn’t.

Is Miley asleep for the surgery?

Probably. These surgeries can easily be done with the patient awake or just sedated, with their arm numbed up. She may be awake enough to look at the cyst but then probably laid back down to let the surgeon keep working. In this picture, Miley has an ID bracelet and what looks like an IV in her right arm, and nothing on the arm with the cyst on it. That means she was at least sedated for the surgery, if not asleep completely.

More Questions?

Post more questions about this type of surgery in the comments below!

Arizona Cardinals safety Rashad Johnson injured his fingertip in a game against the New Orleans Saints last week. How did this happen? What was the surgery like? What happens now? I’ll answer these questions and more in this article.

[Read more…]

Ed Sheeran was in Nashville last night performing at Bridgestone Arena. He somehow cut his hand after the show and wound up in a Nashville ER. He posted pictures of his injury on Instagram – did he cut a tendon or a nerve? [Read more…]

Texas QB David Ash goes to the locker room for x-rays of an injured, bruised wrist

What causes bruising in a wrist injury like David’s?

Bruising is caused by bleeding underneath the skin.

It’s usually a sign of severe trauma in a young person, whose bones are harder and ligaments thicker than an older person.

In a young person, several layers of anatomy have to be damaged to see bleeding underneath the skin after a wrist injury.

For example, bleeding from a broken bone has to pass from the broken bone edge, up through the muscles or tendons, through the tendon covering (called fascia), and spread underneath the skin and fat layer.

That’s why bruising after a wrist injury is often a sign of a broken wrist.

What is a wrist contusion?

A contusion just means an injury caused by a direct blow, or direct impact.

The blow can be from landing directly on the wrist on the ground or from another player’s pads or helmet striking the wrist.

Contusions are usually minor injuries, don’t require surgery, and heal quicker than sprains, though they can hurt a lot.

An example of what a smashed, broken, fractured wrist looks like

In the picture below, you can see the dark purple bruising in the wrist and hand (compare to the normal color in the fingertips) one day after this patient broke her wrist. X-rays of this wrist show a smashed radius fracture in several pieces. This is a fracture that needs surgery.

Keep in mind that she is older and her skin, bones, and ligaments are weaker, so bruising and swelling will be worse than in a young person.