Residual Wrist Pain and Cyst Recurrence Following Removal of Dorsal Ganglion With and Without Posterior Interosseous Nerve Neurectomy.

PURPOSE: Pain from dorsal wrist ganglion cysts may result from irritation of the terminal branch of the posterior interosseous nerve. Excision of this branch is often used to treat wrist pain from various etiologies, including recurrent dorsal wrist cysts. This study examines the effect of performing concurrent posterior interosseous nerve neurectomy (PINN) during primary cyst excision. We hypothesize that concurrent PINN reduces postoperative pain and lowers the need for repeat cyst excision compared with excision alone.

METHODS: A retrospective chart review identified 173 patients who underwent open primary dorsal wrist ganglion excision from 2015 to 2024. Phone interviews were completed with 73 patients, 37 with PINN and 36 without, at mean follow-ups of 4.4 and 6.3 years after surgery, respectively, to collect Quick Disabilities of the Arm, Shoulder, and Hand scores, persistent pain intensity and duration, cyst recurrence, reexcision, and patient satisfaction.

RESULTS: There were no statistically significant differences between the PINN and non-PINN groups' Quick Disabilities of the Arm, Shoulder, and Hand scores regarding patient satisfaction, level of pain, cyst recurrence, and improvement of pain following surgery (P = .7). There was a nonsignificant decrease in pain scores in the PINN group compared with the non-PINN group (P = .26). Among patients with recurrence, there was a nonsignificant increase in pain scores in the PINN group compared with the non-PINN group (P = .83). The rate of cyst recurrence was 13.5% (5/37) in the PINN group and 27.8% (10/36) in the non-PINN group, which was nonsignificant (P = .16). None of the patients with cyst recurrence in the PINN group sought reintervention, whereas 4/10 patients who did not undergo concurrent PINN sought reintervention.

CONCLUSIONS: This study failed to show that PINN during dorsal wrist ganglion excision significantly affects clinical outcomes. Further research is needed to evaluate whether concurrent PINN influences cyst recurrence rates and the need for reintervention after recurrence.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.