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American Association for Hand Surgery

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You Have Got Some Nerve: Joint Denervation for Thumb Carpometacarpal Joint Arthritis
James Ross Bailey, MD, Southern Illinois School of Medicine, Springfield, IL, David C Tapscott, MD, Southern Illinois University School of Medicine, Springfield, IL and Paul W Gorman, MD, Trinity Hand Specialists, Johnson City, TN

Introduction
First carpometacarpal (CMC) joint arthritis in the younger, high demand patient is problematic, and, as of yet, there is no definitive treatment strategy. While first CMC joint arthroplasty is a treatment option, there is an associated extended time for recovery as well as concern about the longevity of the reconstruction. Furthermore, in higher demand individuals, there may be some additional consideration of residual grip strength and thumb stability for more intensive activities. In this study, we evaluated denervation of the first carpometacarpal joint as a treatment for thumb CMC joint arthritis in the relatively young patient.

Material & Methods
In this IRB approved study, prospectively collected data on 56 thumbs in 51 patients being treated for first CMC joint arthritis with an average follow up period of 12.8 months and an average age of 49 years was retrospectively evaluated. The patients in this cohort were treated with an open denervation procedure of their first CMC joint as described by Dr. Arenas-Prat. The patients were selected for the procedure by the treating surgeon based on their age, activity level, and goals. Preoperative and postoperative VAS, Jamar, and Quick Dash Data was used to evaluate the outcomes, and patients with complete preoperative and postoperative values were analyzed for each outcome score analysis.

Results
Preoperative average Quick Dash was 47.7 and postoperative Quick Dash improved to 17.28 (P<0.0001). There was no statistically significant change in the average grip Jamar grip strength, average 59.0 preoperatively and 59.9 postoperatively. The VAS pain score decreased from an average of 7.65 preop to 0.95 post op (P<0.0001). Results are listed in Table 1. There were no reoperations or postoperative complications in any of the participants during this study.

Conclusions
In younger patients, a CMC denervation procedure of the first carpometacarpal joint tends to provide reliable improvement in patient disability and pain without affecting grip strength and with a low complication rate.




Patients with Complete Data


Pre Op Value


Post Op Value


P Value


QuickDash


50


47.7


17.2


<0.0001


Jamar Strength


53


59.1


59.9


0.758


VAS


20


7.65


0.95


<0.0001


Table 1: Outcome Results
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