Dorsal Wrist Ganglion: Pilot for Randomized Control Trial Comparing Aspiration Alone or Combined with Injection of Platelet-Rich Plasma

Abstract

This pilot study assessed the feasibility of performing a randomized control trial (RCT) investigating injection with platelet-rich plasma (PRP) for dorsal wrist ganglion (DWG). Aspiration alone was compared with aspiration plus injection of PRP. Seventeen patients were enrolled. Nine patients received PRP and eight aspiration alone. Patients were followed up at 6 weeks and 1 year; recurrence of the ganglion and Patient Evaluation Measure scores were measured. At 6 weeks seven patients in the aspiration group had a recurrence and five in the PRP group, but by 1 year, this has increased to seven out of eight in the PRP group whereas in the aspiration group four had resolved leaving three out of eight patients with a ganglion still present. From the basis of our work an RCT would require a minimum of 46 patients per group; however, it is unlikely that PRP will be a panacea for ganglia. This is a Level II study.

Keywords

platelet-rich plasma - ganglion - aspiration - wrist - dorsal

Note

The trial was registered on clinicaltrials.gov—Record Number: 1/091/17 (NCT03408808).

Ethical Approval

The research protocol was approved in advance by the Wales Research Ethics Committee 5. REC Reference: 17/WA/0425. Only anonymized data are presented and therefore no specific consent is required.

Authors' Contributions

K.H.: Design of protocol, data acquisition, and write up; Y.K.: Data analysis and write up; A.H.: Randomization, data analysis; C.M.: Protocol design; and D.L.: Protocol design and write up.

Publication History

Received: 03 November 2021

Accepted: 31 January 2022

Article published online:
08 June 2022

• References

• 1 Athanasian EA, Green DP, Hotchkiss RN, Pederson WC, Wolfe SW. Green's Operative Hand Surgery. 5th ed. Philadelphia: Churchill Livingstone; 2005: 2211-2265
• 2 Psaila JV, Mansel RE. The surface ultrastructure of ganglia. J Bone Joint Surg Br 1978; 60-B [phone]
• 3 Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med 2008; 1 (3-4): 205-211
• 4 Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg Am 1976; 1 (03) 228-235
• 5 Janzon L, Niechajev IA. Wrist ganglia. Incidence and recurrence rate after operation. Scand J Plast Reconstr Surg 1981; 15 (01) 53-56
• 6 Lowden CM, Attiah M, Garvin G, Macdermid JC, Osman S, Faber KJ. The prevalence of wrist ganglia in an asymptomatic population: magnetic resonance evaluation. J Hand Surg [Br] 2005; 30 (03) 302-306
• 7 Westbrook AP, Stephen AB, Oni J, Davis TR. Ganglia: the patient's perception. J Hand Surg [Br] 2000; 25 (06) 566-567
• 8 Clay NR, Clement DA. The treatment of dorsal wrist ganglia by radical excision. J Hand Surg Am 1988; 13 (02) 187-191
• 9 Osterwalder JJ, Widrig R, Stober R, Gächter A. Diagnostic validity of ultrasound in patients with persistent wrist pain and suspected occult ganglion. J Hand Surg Am 1997; 22 (06) 1034-1040
• 10 Goldsmith S, Yang SS. Magnetic resonance imaging in the diagnosis of occult dorsal wrist ganglions. J Hand Surg Eur Vol 2008; 33 (05) 595-599
• 11 Valente Duarte de Sousa IC, Tosti A, Tosti A. New investigational drugs for androgenetic alopecia. Expert Opin Investig Drugs 2013; 22 (05) 573-589
• 12 Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci 2011; 121 (04) 176-180
• 13 Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP?. Implant Dent 2001; 10 (04) 225-228
• 14 Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004; 62 (04) 489-496