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Partial Denervation For Wrist Pain Can Delay Extensive Surgery

Partial denervation of the wrist may provide enough pain relief to delay the need for more extensive salvage surgery in patients with wrist arthritis.

United States researchers at the Mayo Clinic and Mayo Foundation in Rochester, Minnesota, say partial wrist denervation is useful when reconstructive procedures are either not feasible or not desirable.

They reviewed data on 19 Mayo patients who underwent 20 isolated anterior and posterior interosseous neurectomies in a five-year period. Participants had no previous or concurrent wrist surgery.

At a post-operative median of 2.5 years, 80 percent of participants said they had decreased pain. As well, 45 percent reported normal or increased grip strength. Approximately 73 percent of the working patients returned to their jobs.

The investigators say three patients required additional procedures for pain relief. Two had arthrodesis and one had radial styloidectomy. Denervation also failed in one patient with rheumatoid arthropathy.

Poor preoperative range of motion and workers' compensation status predicted failure, which tended to occur in the first postoperative year. There were no surgical complications.

"Partial denervation of the wrist via the anterior and posterior interosseous nerves is a technically easy procedure and may provide pain relief sufficient to markedly delay the need for more extensive salvage procedures in patients with wrist arthritis," the researchers concluded.
Journal of Hand Surgery, 2002; 27A: 833-839. "Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation"

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