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Buying Time: Long-Term Results of Wrist Denervation and Time to Repeat Surgery
Maureen A. O'Shaughnessy, MD; Sanjeev Kakar, MD
Mayo Clinic, Rochester, MN

Introduction: Wrist denervation has been shown to be a viable option for chronic wrist pain related to articular degeneration or chronic instability. Removal of the sensory innervation to the wrist joint provides relief of pain; however denervation does not address the underlying pathology. Patients continue to undergo degenerative changes and may need revision procedures. This study reviews the 20 year long term outcomes of patients treated with partial wrist (anterior and posterior interosseous nerve) denervation focusing on need for and time to salvage procedure.

Materials and Methods: Retrospective study was performed over a 20 year period of all patients undergoing wrist denervation by the lead authors (1994-2014). At latest follow up data including range of motion, grip strength, radiographic degeneration and revision surgery were recorded.

Results: The series includes 115 wrists in 104 patients (74 male, 30 female) with average age at surgery of 54 (range 18-80). Average follow up was 69 months (range 3 249). The principal diagnoses were scaphoid lunate advanced collapse (SLAC) degenerative arthritis (33%) and radiocarpal arthritis (30%). Average flexion-extension arc was 94 degrees for the affected extremity (77% of contralateral) and average grip strength was 71% of the unaffected extremity. Seventy percent of wrists (81/115) had satisfactory outcomes and did not require revision procedures at average follow up of 69 months (range 3-249). Thirty percent (34/115) underwent revision surgery. The most common procedures were scaphoid excision four corner fusion (13), total wrist fusion (6), proximal row carpectomy (6) and radioscapholunate fusion (4). Time to salvage surgery was on average 24 months after denervation (range 2-165).

Conclusions: Partial wrist denervation is a reliable motion preserving procedure for patients with chronic wrist pain. In this series 70% of patients experienced pain relief and did not require further salvage procedures at an average of 69 months follow up. Thirty percent of patients ultimately underwent salvage procedure. On average patients experienced pain relief for 24 months prior to ultimately undergoing revision operation. The significance of these results better enable surgeons to give time estimates and expectations regarding pain control following wrist denervation in the patient with chronic wrist pain.

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