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The Longevity of Partial and Total Wrist Denervation in Chronic Wrist Pain: A Systematic Review
Danielle Tsirulnikov, BHSc, MScPT
1, Gilad Rotem, BSc, MD
1,2, Jonathan Persitz, M.D.
1; Kevin Zuo, MD, MASc
3(1)University of Toronto, Toronto, ON, Canada, (2)Toronto Western Hospital, Toronto, ON, Canada, (3)Toronto Western Hospital, University Health Network, Toronto, ON, Canada
IntroductionThe mainstay of surgical interventions for chronic wrist pain that have failed conservative management include motion sparing and fusion techniques. Although these procedures may relieve wrist pain, they result in reduced range of motion, have high complication rates, and require prolonged cast immobilization. Wrist denervation is an alternative soft tissue procedure that can effectively relieve pain while maintaining function, and may delay the need for salvage procedures. The aim of our systematic review was to explore the longevity of symptom relief with partial and total wrist denervation.
Materials & MethodsThis systematic review was registered on PROSPERO (CRD42025613565). MEDLINE, Embase, and CINAHL databases were searched. A total of 19 articles were selected, with patients split into two subgroups: total wrist denervation (n=680 wrists, 675 patients) and partial wrist denervation (n=424 wrists, 408 patients). Demographic and surgical outcomes data were collected. We defined our primary outcome (longevity) as time until revision surgery following wrist denervation, and secondary outcomes included post-operative complications, pain, range of motion, grip strength, and patient satisfaction.
ResultsFor total wrist denervation (n= 680 wrists), the weighted mean follow-up was 7.0 years. There were a total of 71 revisions (10.4%), of which 23 reported a weighted mean time to revision surgery of 2.9 years (range 0.4-6.3 years). For partial wrist denervation (n= 424 wrists), the weighted mean follow-up was 6.1 years. There was a total of 90 revisions (21.2%), of which 78 reported a weighted mean time to revision surgery of 2.1 years (range=0.2-13.8 years). For secondary outcomes, 15/15 studies reported clinically significant reduction in pain scores using various scales (e.g. VAS, NPRS, DASH, PRWE). Flexion-extension arc was stated to be slightly increased in 7/8 studies. Grip strength was increased in 8/8 studies. In 8/8 studies, most patients (>65%) reported subjective satisfaction with the procedure. Complication rates were very low for both total and partial denervation (3.2% and 1.9% respectively), most common being sensory changes, neuroma, and CRPS.
Conclusion Partial and total wrist denervation are effective surgical options for achieving substantial pain reduction in chronic wrist pain while preserving function. These procedures can reliably delay the need for more invasive salvage interventions for a period of at least 2-3 years, with most patients (>75%) not requiring further surgery at 6 years. High ranges of longevity may suggest differences in technique as well as patient indications and selection.
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