Causes of Residual Pain after Open Excision of Wrist Ganglion / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to verify the relationship between the residual pain and preoperative carpal instability, as well as the generalized laxity after open excision of wrist ganglion. MATERIALS AND METHODS: Sixty-four patients, who received open excision of wrist ganglion, were retrospectively enrolled. The relationships between residual pain (visual analogue scale, VAS) and postoperative function (quick disabilities of the arm, shoulder and hand, quick-DASH), between residual pain and preoperative carpal instability, as well as generalized laxity were evaluated. The carpal instability was assessed from radiologic carpal instability (dorsal intercalated segment instability and volar intercalated segment instability) and Watson scaphoid shift test. The generalized laxity was assessed by the Beighton hypermobility score. RESULTS: Pain VAS and quick-DASH were significantly improved postoperatively. There was a significant difference in postoperative residual pain between those with (n=6) and without carpal instability (n=58) (+: 2.50±1.76 vs. −: 1.18±1.24; p=0.022), but there was no correlation between carpal instability and postoperative quick-DASH. Both postoperative residual pain and quick-DASH had no correlation with generalized laxity (n=18). CONCLUSION: Patients with preoperative carpal instability had greater residual pain after excision of wrist ganglion than those without.

Instability Patterns of Normal Midcarpal and Radiocarpal Joint in the Sagittal Plane / 대한정형외과학회잡지

The midcarpal joint has inherent instability in the sagittal plane. Several instability patterns of midcarpal joint due to ligament insufficiency have been presented. We ohserved the normal midcarpal and radiocarpal behaviors of ligament laxity in the sagittal plane to investigate the significance of dorsal and palmar stress test which has been used for evaluation of the non-dissociative carpal instahilities. We performed the dorsal and palmar displacement stress test on fifty pairs of normal wrist joints under the flouroscopic views. The midcarpal joints were subluxed, more on dorsal stress, with variable degrees. Dorsal subluxations in females and third decades were more prominent than males and fourth decades. Three types of radiocarpal instability on dorsal stress test could be observed. We think that displacement stress test in the sagittal plane should be interpreted in consideration of normal instability patterns in the evaluation of ahnormal midcarpal and radiocarpal instabilities since there are variable patterns and degrees of ligament laxity in normal wrist joints.