Routine radiographs unnecessary for dorsal wrist ganglion diag Academy News 2007 AAOS Annual Meeting

Routine radiographs found unnecessary for dorsal wrist ganglion diagnosis

By Peter Pollack

Routine radiographs are unlikely to alter the management of dorsal wrist ganglions and often add an unnecessary expense, according to the authors of poster exhibit P235. Eliminating the use of such routine radiographs could save the U.S. health system from $4.7 million to $11.8 million each year, say the researchers.

Dorsal ganglions are frequently referred to orthopaedic surgeons for diagnosis and treatment (referral incidence of 55 per 100,000). Although the ganglions are comparatively easy to diagnose, many orthopaedic surgeons order wrist radiographs as a screening exam. Because the cost of such radiographs can range from $28.94 each (Medicare reimbursement) to as much as $72.00 or more each (institution fee), researchers hoped to identify the costs and benefits of this practice.

Researchers examined the charts of 102 patients with confirmed diagnoses of dorsal wrist ganglion on aspiration or excision. They reviewed patient data such as age, gender, side of ganglia, hand of dominance, history of trauma, range of motion, and radiographic and pathologic results. Of the 102 patients, researchers confirmed positive radiographic findings in 13 cases, and of those 13, seven had been previously known. Clinical management for the remaining six patients did not change as a result of the radiographic findings.

Given the incidence of radiographic findings in this study, the cost per positive finding ranged from $227.07 to $564.92 across all of the patients. Extending these numbers to the 165,000 cases of dorsal ganglions in the United States each year produces a total yearly cost of $4,775,000 to $11,880,000. Because of the significant cost and low odds of altering treatment, researchers recommend against the routine use of radiographs in screening the typical presentation of dorsal wrist ganglions.

The lead researcher for is Derek R. Johnson, MD, of Grand Rapids, Mich. Additional researchers included Timothy W. Powers, MD, of Holland, Mich., and Julian E. Kuz, MD, of Grand Rapids, Mich. The authors report no conflicts of interest.

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