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General Rehabilitation

Can a Ganglion Cyst Be Career-Ending? A Physiatric Approach to Recovery in a Violinist with Post-Surgical Wrist Pain

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater
Has Audio

    Poster Presenter(s)

  • Jonathan Choi, Other

    Medical Student
    University of North Texas HSC Fort Worth Texas College of Osteopathic Medicine
    Lewisville, Texas

  • Sharon Nguyen, Other

    Medical Student
    University of North Texas HSC Fort Worth Texas College of Osteopathic Medicine
    Fort Worth, Texas

    • Co-Author(s)

  • YL

    Yein Lee, DO

    Associate Professor - Chair, Division of Performing Arts Medicine
    University of North Texas Health Science Center
    Dallas, Texas

Disclosure(s):
Jonathan Choi, Other: No financial relationships to disclose
Sharon Nguyen, Other: No financial relationships to disclose
Case Diagnosis: A 45-year-old professional violinist with persistent wrist pain following ganglionectomy, struggling to return to peak performance.

Case Description or Program Description: The patient had a two-year history of left wrist pain, described as “possibly career-ending.” A ganglion cyst was diagnosed after an intensive music festival. Conservative management failed, leading to excision, but she continued experiencing aching, stiffness, and tightness, limiting performance. Examination was unremarkable except for pain reproducible while playing the violin, particularly in difficult passages. MRI showed fluid around the second, third, and fourth dorsal extensor tendons.
A targeted corticosteroid injection was planned. Under ultrasound guidance, the third dorsal compartment was marked, and a local anesthetic block was performed. The patient played immediately to confirm pain relief before the injection. She was referred to an occupational therapist specializing in violinists, with a structured return-to-play protocol to gradually increase playing time, dexterity, and endurance. Osteopathic Manipulative Treatment, strengthening, and lifestyle modifications, including sleep and nutrition optimization, were also implemented.

Setting: Performing Arts Medicine Clinic / Outpatient Musculoskeletal Medicine Clinic

Assessment/Results: The tailored approach led to significant improvements. Pain subsided, fine motor control and endurance improved, and patient successfully returned to professional performances with minimal discomfort.

Discussion (relevance): Ganglion cysts are common wrist pathologies, with most patients recovering well post-ganglionectomy. However, for musicians, recovery can be complicated by the unique physical demands of their craft. This case underscores the importance of examining their functional tasks (playing evaluation), precise intervention under ultrasound guidance, coordination of rehabilitation plan with precise diagnostic techniques, and individualized rehabilitation. A combination of these approaches is critical for optimizing recovery in performing artists.

Conclusions: A straightforward musculoskeletal pathology could derail a professional musician's career due to the demands of their occupation. However, a physiatric approach that includes precise ultrasound-guided injections, multidisciplinary care, and tailored return-to-play instructions is necessary to allow musicians to safely return to their peak performance.