Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel

Balazs, George C.; Donohue, Michael A.; Drake, Matthew L.; Ipsen, Derek; Nanos, George P.; Tintle, Scott M.

doi:10.1016/j.jhsa.2015.05.030

Cited by 21 publications

(40 citation statements)

References 35 publications

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“…Specifically, pushups, which are a core component of daily training and physical fitness assessments, axially load the hyperextended wrist and may be difficult to perform even after less invasive procedures, such as dorsal ganglion excision. [18][19][20][21] The patients in the present military cohort lost on average 27% of their flexion-extension arc, with 15 (37.5%) patients experiencing a loss of 50% or more of their ROM, and only 60% of the cohort reported the ability to return to standard pushups. The inability to perform physically demanding activities likely lead contributed most significantly to the low return to duty rate.…”

Section: Discussionmentioning

confidence: 99%

“…These events include pushups, an activity which axially loads a hyperflexed wrist and can be difficult to perform with wrist pathology. [18][19][20][21] The purpose of this analysis is to characterize the demographics, surgical outcomes, and complications following PLDs/PLFDs in the U.S. military. We hypothesize that following reduction and surgical fixation of PLDs, active duty service members will experience poor functional outcomes and a respectively low return to duty rate.…”

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confidence: 99%

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Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military

et al. 2017

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Perilunate dislocations and perilunate fracture dislocations (PLDs/PLFDs) are rare and often associated with poor outcomes. Heretofore, these outcomes have not been evaluated in a high-demand military population. The purpose of this study was to evaluate the outcomes in a young, active population after sustaining PLD/PLFD injuries. We retrospectively reviewed the U.S. military service members who underwent surgical treatment for a PLD/PLFD (Current Procedural Terminology codes 25695 and 25685) between June 1, 2010, and June 1, 2014 through the Military Health System Management Analysis and Reporting Tool (M2) database, capturing patients with a minimum 2-year follow-up. Patient characteristics and outcomes were gathered; however, radiographic analysis was not possible. In this study, 40 patients (40 wrists) were included with an average follow-up of 47.8 months. The average age was 28.8 years. Twenty-two injuries (55%) were PLFD and 22 (55%) cases involved the nondominant extremity. On initial presentation, 11 (27.5%) were missed and 50% of patients were presented with acute carpal tunnel syndrome. Range of motion (ROM) was 74% and grip strength was 65% compared with the contralateral wrist; 78% reported pain with activity and only 55% remained on active duty status at final follow-up. Injuries to the nondominant extremity were significantly more likely to experience a good to excellent outcome and regained a more ROM. Patients with ligamentous PLD had less pain at rest and were more likely to return to sport. Worse outcomes can be expected for PLD/PLFD of the dominant extremity, transscaphoid PLFD, greater arc injuries, and those undergoing pinning alone. A high-demand patient may expect worse functional results with a higher degree of limitation postoperatively. The level of evidence is therapeutic IV.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military

et al. 2017

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“…Also, females are more likely to develop Chronic Pain Syndrome (CRPS) following surgical treatment of DRF [24,25], with an estimated odds ratio of 3 to 4 [26]. However, other studies did not find predictive effect of gender after CTR [27] or on recurrence after Open Ganglion Excision [28]. Slutsky et al proposed that these differences in the effect of gender on outcome might be due to differences in expectations, functional demands and pain tolerance between genders [29].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for limited improvement after total trapeziometacarpal joint arthroplasty

Mosegaard

Stilling

Hansen

2020

Health Qual Life Outcomes

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Background: Trapeziometacarpal (TMC) osteoarthritis can be painful and cause disability for patients. Total joint replacement of the TMC joint provides a pseudo arthrosis with good restoration of the thumb motion and pain relief in most patients. But there is also a risk of no improvement following the operation. The purpose of this study was to identify patients at risk of no clinically important improvement following operative treatment of osteoarthritis of the TMC joint. Methods: We included 287 consecutive patients (225 women, 62 men) treated with total joint replacement of the TMC joint due to osteoarthritis with a mean age of 58.9 years (range 41-80) in a prospective cohort study. We collected information preoperatively and 12 months postoperatively on disabilities of the arm, shoulder and hand score (DASH), grip strength and pain at rest and activity on a visual analogue scale (VAS).Results: We found a statistically significant improvement in DASH from 42.0 to 15.9 (p < 0.001), VAS at rest from 3.5 to 0.6 (p < 0.001), VAS at activity from 7.9 to 2.5 (p < 0.001) and grip strength from 21.6 kg to 27.6 kg (p < 0.001) 12 months after the operation, when analysed as a group. There was an increased risk of no clinically important improvement in hand function for patients with preoperative high preoperative grip strength. Also, we found an increased risk of no clinically important improvement in female patients when using VAS as outcome. Conclusion: However, we were unable to detect one isolated preoperative predictor as indicator of successful result after operative treatment of TMC osteoarthritis, and as so it was not possible to establish a clinical valid tool for patient selection before surgery. Informed consent was obtained from all patients for being included in the study. The study needed no approval from The Regional Committee of Biomedical Research Ethics as the data was collected, as part of our normal pre-and postoperative clinical pathway, but the study is part of an outcome study of the results after total joint arthroplasty (TJA) of the TMC joint registered in Clinicaltrials.gov (NCT01554748). Trial registration: Clinicaltrials.gov (NCT01554748). Registered 15 March 2012.

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“…Owing to activity and duty demands, military service members experience a higher rate of hand and wrist pathology compared with the civilian populations. 9 Also, younger military populations have higher preoperative expectations, which may affect patientcentered outcome scores negatively. For these reasons, outcomes of upper-extremity injuries in the military have been guarded compared with those in the civilian population.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Typically, nonsurgical management, including immobilization, anti-inflammatory medication, and intra-articular corticosteroid injections, is first attempted for acute traumatic tears without instability. 6 Surgical intervention is considered for distal radioulnar joint instability, recalcitrant symptoms, or acutely 7,8 in high-demand athletic or military populations 9 with a corresponding history, physical examination, and advanced imaging. We offer conservative management to everyone, but patients who have continued pain after 4 weeks of a short-arm cast with positive magnetic resonance imaging (MRI) findings of TFCC pathology are offered arthroscopic evaluation with possible repair.…”

mentioning

confidence: 99%

Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Foveal Tear Repair in the United States Military

Dunn

Polmear

Daniels

et al. 2019

Journal of Hand Surgery Global Online

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Purpose: To compare subjective and objective midterm functional clinical outcomes of knotless arthroscopic assisted transosseous (AAT) triangular fibrocartilage complex (TFCC) repairs specifically in a cohort of military service members. Methods: Patient charts were reviewed to identify all cases of TFCC repair by a single surgeon from 2012 to 2016. Primary outcome variables were the QuickeDisabilities of the Arm, Shoulder, and Hand score and return to full military duty. Secondary outcome variables were visual analog scale for pain, Mayo Modified Wrist Score, Single-Assessment Numeric Evaluation, and the number of push-ups in 2 minutes during a record physical fitness test. Inclusion criteria were adult active duty service members who underwent AAT TFCC repair with a minimum of 2 years' follow-up. Terminal follow-up was determined by a telephone interview. Exclusion criteria were distal radioulnar joint instability, revision procedures, cases involving other ligamentous repair procedures, and those with an incomplete medical record or who could not be reached for the survey. Results: Fifteen patients, average age 21 years (range, 18e29 years), met inclusion and exclusion criteria with mean follow-up of 3.8 years (range, 2e5.9 years). Average QuickeDisabilities of the Arm, Shoulder, and Hand score was 9.7 (range, 0e29.5) and 93% were able to remain on active duty. Average secondary outcomes scores were: visual analog scale ¼ 1.3 (range, 0e4); Single-Assessment Numeric Evaluation ¼ 87.3 (range, 30e100); Mayo Modified Wrist Score ¼ 84.3 (range, 55e100); and push-ups ¼ 72 (range, 42e90) in 2 minutes. One patient required a secondary surgery. Conclusions: Knotless AAT TFCC repair may be a safe and effective procedure that may return military service members to a preinjury level of activity. Type of study/level of evidence: Therapeutic IV.

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Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel

Cited by 21 publications

References 35 publications

Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military

Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military

Risk factors for limited improvement after total trapeziometacarpal joint arthroplasty

Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Foveal Tear Repair in the United States Military

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