Denervation Atrophy, Ganglion Cysts, Hand Ganglion, Wrist Ganglion
Conditions
Keywords
ganglion cysts, dorsal wrist ganglia, neurectomy, denervation, posterior interosseous nerve
Brief summary
The purpose of this study is to determine if a statistical significance exists between outcomes of patients treated for dorsal wrist ganglion cyst with excision alone versus excision and the addition of a partial wrist denervation by resecting the common terminal sensory branch of the PIN (posterior interosseus nerve). Our hypothesis is that addition of PIN improves outcome after dorsal wrist ganglion excision as indicated by post-operative pain, function, ability to perform activities of daily living, and physical exam findings.
Detailed description
The primary endpoint will be outcomes on subject surveys and questionnaires. Data will be collected pre- and post-operatively at 2 weeks, 12 weeks, 6 months, and one year. Four questionnaires will be used, including the Visual Analog Pain Score (VAS), Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI), and the PROMIS Pain Behavior (PB) questionnaires. Secondary outcomes include physical examination consisting of pre- and post-operative pinch and grip strength testing, and active range of motion including wrist flexion and extension ulnar and radial deviation, and weight bearing extension. These will be performed at 2 weeks, 12 weeks, and 6 months post-operatively.
Interventions
PROCEDUREDorsal wrist ganglion alone (DWG)
Patients assigned to this arm will undergo dorsal wrist ganglion cyst excision alone.
PROCEDUREDWG/PIN
Patients assigned to this arm will undergo dorsal wrist ganglion excision and the addition of a partial wrist denervation by resecting the common terminal sensory branch of the posterior interosseus nerve (PIN)..
Sponsors
Kenneth Taylor, M.D.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
The patient and the study team member who is performing the physical exam (including range of motion and grip/pinch strength testing) will be blinded to the randomization.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Greater than or equal to 18 years of age * Gender: male/female (non-pregnant) * Diagnosis of symptomatic (pain and limited ability to perform activities of daily living) dorsal wrist ganglion cyst * Subjects who have chosen surgical management for their ganglion cyst diagnosis * Fluent in written and spoken English * Subject is able to provide voluntary, written informed consent * Subject, in the opinion of the clinical investigator, is able to understand the clinical investigation and is willing to perform all study procedures and follow-up visits * Non-Prisoners
Exclusion criteria
* Less than 18 years of age * Non-elective surgery for this diagnosis * Chronic wrist instability of the operative extremity * Comorbid neurologic maladies of the operative extremity * Prior wrist surgery on either extremity * Non-English speaking * Prisoners * Pregnancy * Cognitive Impairment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain measured with the Visual Analog Pain Scale (VAS) | Preop to One Year Post-Op | Self-report measurement that assesses a person's perceived level of pain |
| Physical Function measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) | Preop to One Year Post-Op | 11-Item questionnaire that measures physical function and symptoms in people with musculoskeletal disorders of the upper limb |
| Pain interference measured with the Patient-Reported Outcomes Measurement Information (PROMIS) Pain Interference instrument | Preop to One Year Post-Op | This instrument measures the self-reported consequences of pain on relevant aspects of one's life and may include the extent to which pain hinders engagement with social, cognitive, emotional, physical, and recreational activities. |
| Pain behavior measured with the Patient-Reported Outcomes Measurement Information (PROMIS) Pain Behavior instrument | Preop to One Year Post-Op | This instrument measures self-reported external manifestations of pain: behaviors that typically indicate to others that an individual is experiencing pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in strength utilizing hand grip measurements | Preop to 6 Months Post-Op | This measurement provides information about muscle strength health in the hand and forearms. The average of three measurements is taken using a hand-held dynamometer |
| Change in strength utilizing finger lateral pinch measurements | Preop to 6 Months Post-Op | This measurement provides information about the functional strength of one's pinching action of the hand using a mechanical pinch gauge. The average of three measurements will be taken at each time frame. |
| Change in strength utilizing finger tip pinch measurements | Preop to 6 Months Post-Op | This measurement provides information about the functional strength of one's pinching action of the hand using a mechanical pinch gauge. The average of three measurements will be taken at each time frame. |
| Change in strength utilizing finger three-point pinch measurements | Preop to 6 Months Post-Op | This measurement provides information about the functional strength of one's pinching action of the hand using a mechanical pinch gauge. The average of three measurements will be taken at each time frame. |
| Change in wrist flexion | Preop to 6 Months Post-Op | This measurement indicates the range of motion of the wrist utilizing a goniometer |
| Change in wrist extension | Preop to 6 Months Post-Op | This measurement indicates the range of motion of the wrist utilizing a goniometer |
| Change in wrist weight bearing extension | Preop to 6 Months Post-Op | This measurement indicates the range of motion of the wrist utilizing a goniometer |
| Change in wrist ulnar deviation | Preop to 6 Months Post-Op | This measurement indicates the range of motion of the wrist from side to side. This movement flexes the hand toward the ulnar bone in the arm. This is measured with a goniometer. |
| Change in wrist radial deviation | Preop to 6 Months Post-Op | This measurement indicates the range of motion of the wrist from side to side. This movement flexes the hand toward the radial bone in the arm. This is measured with a goniometer. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKenneth Taylor, MD
Penn State Health Milton S Hershey Medical Center
Outcome results
None listed