Wrist Denervation for Painful Conditions of the Wrist

Purpose To evaluate the long-term (6-y) results of Wilhelm's wrist denervation technique used as an isolated procedure for painful conditions of the wrist. Methods We conducted a retrospective review of 49 wrist denervations that were performed as isolated procedures in patients with painful wrist conditions. Indication for surgery was degenerative osteoarthritis of the wrist caused by scaphoid nonunion advanced collapse in 19 patients, Kienbock's disease in 13 patients, and primary degenerative osteoarthritis in 17 patients. Results The results were analyzed as a group and by comparing the 3 etiologies. Average pain improvement after surgery for all groups was 68% +/- 8% after the first month and reached a plateau at the end of the first year, with the percentage remaining stable at 36 months at 79% +/- 4%. Grip strength on the treated side improved from 43% of the opposite side before denervation to 69% of the opposite side. The range of motion showed improvements in all axes of movement, without statistical differences between groups. Radiological evaluation after 72 months revealed worsening in 34 patients. There was no difference in results between the 3 groups with regard to grip strength, range of motion, or pain relief obtained. Conclusions Wrist denervation resulted in improvement in pain scores in 39 patients despite radiological deterioration noted in 34 after 6 years. (J Hand Surg 2011;36A:961-966. Copyright (C) 2011 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.