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Clark D, Dingle M, Saxena S, Dworak T, Nappo K, Balazs GC, Nanos G, Tintle S. Prospective Evaluation of Push-up Performance and Patient-Reported Outcomes Following Open Dorsal Wrist Ganglion Excision in the Active-Duty Military Population. J Wrist Surg 2022; 11:493-500. [PMID: 36504534 PMCID: PMC9731736 DOI: 10.1055/s-0042-1743118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
Background Dorsal wrist ganglia (DWG) are a common wrist pathology that affects the military population. This study prospectively evaluates push-up performance, functional measures, and patient-reported outcomes 6 months after open DWG excision in active-duty patients. Methods Twenty-seven active-duty patients were enrolled and 18 had complete follow-up. Included patients had DWG diagnosis, unilateral involvement, and no previous surgery. The number of push-ups performed within 2 minutes was measured preoperatively and at 6 months. Range of motion (ROM), grip strength, Pain Catastrophization Scale (PCS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score, and visual analog scale (VAS) pain score were measured preoperatively and at 2 weeks, 6 weeks, 3 months, and 6 months. Results Push-up performance did not significantly change overall. Wrist flexion, extension, and radial deviation returned to preoperative ranges. Wrist ulnar deviation significantly increased from preoperative range. Grip strength deficit between operative and unaffected extremities significantly improved to 0.7 kg at 6 months from preoperative deficit of 2.7 kg. Mean scores significantly improved for the validated outcome measures-PCS from 6.3 to 0.67, VAS pain scores from 1.37 to 0.18, DASH scores from 12.8 to 4.3, and Mayo Wrist Scores from 80.3 to 89.4. No surgical complications or recurrences were reported. Conclusions Findings suggest that almost half of active patients may improve push-up performance after DWG excision at 6 months. Significant improvements were seen in wrist pain, ROM, grip strength, and all patient-reported outcomes, which is useful when counseling patients undergoing excision.
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Affiliation(s)
- DesRaj Clark
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Marvin Dingle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Sameer Saxena
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Theodora Dworak
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Kyle Nappo
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | | | - George Nanos
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Scott Tintle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
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Dworak TC, Balazs GC, Tropf J, Nanos GP, Tintle SM. Epidemiology of Symptomatic Dorsal Wrist Ganglia in Active Duty Military and Civilian Populations. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:349-353. [PMID: 35415521 PMCID: PMC8991698 DOI: 10.1016/j.jhsg.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose The epidemiology of dorsal wrist ganglia (DWG) has been poorly studied. The purpose of this study was to determine the epidemiology of DWG in the US military and civilian populations. We hypothesized that military service would be associated with an increased risk for developing a DWG. Methods The US Department of Defense Management Analysis and Reporting Tool, a database of health care encounters by military personnel and dependents, was queried for encounters with an International Classification of Diseases, Ninth Revision diagnosis of 727.41 (ganglion of a joint) or 727.43 (ganglion, unspecified location) between 2009 and 2014. There is no specific code for DWG, so a random sample of 1,000 patients was selected from both the military and civilian cohorts. These 2,000 electronic medical records were examined to identify patients with a DWG. This estimate was used to determine the unadjusted incidence of DWG with a 95% confidence interval and a 5% margin of error in the entire military and civilian dependent population. Adjusted incidence rates and incidence rate ratios (IRR) were determined using Poisson regression, controlling for demographic covariates. Results The incidence of DWG in the military population is 14.25/10,000 person-years compared with 7.01/10,000 person-years in the civilian population. Female sex was a significant risk factor in both the military (IRR, 2.59) and civilian populations (IRR, 2.26). Younger age group (age 25–34 years) was a significant risk factor for DWG compared with an older age group (age 45–64 years) in both the military (IRR, 1.74) and civilian populations (IRR, 2.56). Senior rank (both officer and enlisted) was a significant risk factor for DWG compared with junior rank (IRR, 1.95). Conclusions The incidence of DWG was higher in the military compared with the civilian population. There is a higher incidence of a DWG in females and in the senior ranks (both officer and enlisted). Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Theodora C. Dworak
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - George C. Balazs
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jordan Tropf
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - George P. Nanos
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Scott M. Tintle
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA
- Corresponding author: Scott Tintle, MD, Department of Orthopaedics, Walter Reed National Military Medical Center, America Building, 2nd Floor, 8901 Wisconsin Avenue, Bethesda, MD.
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Lui TH. Endoscopic Ganglionectomy of the Volar Radial Wrist Ganglion. Arthrosc Tech 2017; 6:e1477-e1480. [PMID: 29354461 PMCID: PMC5709611 DOI: 10.1016/j.eats.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023] Open
Abstract
Volar ganglion cyst of the wrist is a common hand problem faced by orthopaedic surgeons. Excision is indicated if it is painful. Arthroscopic ganglionectomy of the wrist ganglion has been reported with the advantage of minimally invasive surgery. Most of them involve elimination of the valvular mechanism and internal drainage of the ganglion fluid to the wrist joint. The access of the ganglion sac is limited especially for a multiloculated cyst. The purpose of this Technical Note is to report the technique of endoscopic resection of the volar radial wrist ganglion. This can ensure complete resection of the ganglion sac especially for the multiloculated one.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(H.K.), F.R.C.S.(Edin.), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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Balazs GC, Dworak TC, Tropf J, Nanos GP, Tintle SM. Incidence and Risk Factors for Volar Wrist Ganglia in the U.S. Military and Civilian Populations. J Hand Surg Am 2016; 41:1064-1070. [PMID: 27663053 DOI: 10.1016/j.jhsa.2016.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 07/20/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the incidence and demographic factors associated with volar wrist ganglia in both military and civilian beneficiary populations. METHODS The U.S. Department of Defense Management Analysis and Reporting Tool (M2) accesses a comprehensive database of all health care visits by military personnel and their dependents. Because there is no specific code for ganglions of the wrist, the database was searched for all military personnel and civilian beneficiaries with an International Classification of Diseases, 9th Revision, diagnosis of 727.41 (ganglion of a joint) or 727.43 (ganglion, unspecified location) between 2009 and 2014. Two random samples of 1000 patients were selected from both the military and the civilian beneficiary cohorts, and their electronic medical records were examined to identify those with volar wrist ganglia. The proportion of volar wrist ganglia was then applied to the overall population data to estimate the total incidence with a 95% confidence interval and 5% margin of error. Unadjusted incidence rates and adjusted incidence rate ratios were determined using Poisson regression, controlling for age, sex, branch of military service, and military seniority. RESULTS The unadjusted incidence of volar wrist ganglia is 3.72 per 10,000 person-years (0.04%/y) in female civilian beneficiaries, 1.04 per 10,000 person-years (0.01%/y) in male civilian beneficiaries, 7.98 per 10,000 person-years (0.08%/y) in female military personnel, and 3.73 per 10,000 person-years (0.04%/y) in male military personnel. When controlled for age, military personnel have a 2.5-times increased rate of volar wrist ganglia, and women have a 2.3-times increased rate. In the military cohort, female sex, branch of service, and seniority were significantly associated with the diagnosis of a volar wrist ganglion when controlled for age. In the civilian beneficiary cohort, only female sex was significant. CONCLUSIONS Military service members have higher rates of volar wrist ganglia diagnoses than their age- and sex-matched civilian counterparts. Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status. CLINICAL RELEVANCE The epidemiology of volar wrist ganglia is poorly defined, and few studies have firmly defined demographic factors associated with the diagnosis. We provide the overall incidence rate of the diagnosis and report a significant association with female sex even when controlled for age.
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Affiliation(s)
- George C Balazs
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Theodora C Dworak
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jordan Tropf
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - George P Nanos
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott M Tintle
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD.
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Balazs GC, Donohue MA, Drake ML, Ipsen D, Nanos GP, Tintle SM. Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel. J Hand Surg Am 2015; 40:1739-47. [PMID: 26228481 DOI: 10.1016/j.jhsa.2015.05.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the most common presenting complaints of active-duty service members with isolated dorsal wrist ganglions and to determine the rate of return to unrestricted duty after open excision. METHODS Surgical records at 2 military facilities were screened to identify male and female active duty service members undergoing isolated open excision of dorsal wrist ganglions from January 1, 2006 to January 1, 2014. Electronic medical records and service disability databases were searched to identify the most common presenting symptoms and to determine whether patients returned to unrestricted active duty after surgery. Postoperative outcomes examined were pain persisting greater than 4 weeks after surgery, stiffness requiring formal occupational therapy treatment, surgical wound complications, and recurrence. RESULTS A total of 125 active duty military personnel (Army, 54; Navy, 43; and Marine Corps, 28) met criteria for inclusion. Mean follow-up was 45 months. Fifteen percent (8 of 54) of the Army personnel were given permanent waivers from performing push-ups owing to persistent pain and stiffness. Pain persisting greater than 4 weeks after surgery was an independent predictor of eventual need for a permanent push-up waiver. The overall recurrence incidence was 9%. No demographic or perioperative factors were associated with recurrence. CONCLUSIONS Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- George C Balazs
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Michael A Donohue
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Matthew L Drake
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Derek Ipsen
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - George P Nanos
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Scott M Tintle
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
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