Posterior Interosseous Neurectomy Alternative for Treating Chronic Wrist PainFunding None.
07 April 2018
21 December 2018
29 January 2019 (online)
Background Wrist denervation is one of the several available options for treating chronic wrist pain; partial wrist denervation performed through a single dorsal incision by resecting the distal posterior interosseous nerve provides good outcomes.
Questions/Purposes This study evaluated the results of posterior interosseous neurectomy (PIN) in patients with chronic wrist pain secondary to scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC).
Methods In total, 30 wrists obtained from 28 patients (25 males, 3 females) were assessed. The dominant hands of 25 (right-handed) patients, nondominant hands of 5, and both hands of 2 were considered. The average age at the time of surgery was 35 (range: 19–50) years, and the average follow-up duration was 18 (range: 12–30) months. Fifteen and 13 patients had wrists with SNAC and SLAC, respectively, and all of those underwent PIN performed through the dorsal approach. The pre- and postoperative range of motion, grip strength, and pain relief percentage were recorded for all the 30 wrists.
Results The average postoperative Disabilities of the Arm, Shoulder and Hand score was 30 (range: 20–80), and the difference between the pre- and postoperative scores was statistically significant. Ninety percent of the patients were satisfied with the results of PIN and reported improvement in grip strength and pain relief.
Conclusions Thus, PIN may be an effective surgical technique for wrist reconstruction.
Clinical Relevance To help patients challenge pain and maintain their wrist joint range of motion.
- 1 Grafe MW, Kim PD, Rosenwasser MP, Strauch RJ. Wrist denervation and the anterior interosseous nerve: anatomic considerations. J Hand Surg Am 2005; 30 (06) 1221-1225
- 2 Sauerbier M. Denervation of the wrist. In: Berger R. , ed. Hand Surgery. Philadelphia, PA: Lippincott Williams and Wilkins; 2004
- 3 Weinstein LP, Berger RA. Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation. J Hand Surg Am 2002; 27 (05) 833-839
- 4 Dellon AL. Partial dorsal wrist denervation: resection of the distal posterior interosseous nerve. J Hand Surg Am 1985; 10 (04) 527-533
- 5 Hofmeister EP, Moran SL, Shin AY. Anterior and posterior interosseous neurectomy for the treatment of chronic dynamic instability of the wrist. Hand (NY) 2006; 1 (02) 63-70
- 6 Berger RA. Partial denervation of the wrist: a new approach. Tech Hand Up Extrem Surg 1998; 2 (01) 25-35
- 7 Wilhelm A. Innervation of the joints of the upper extremity [in German]. Z Anat Entwicklungsgesch 1958; 120 (05) 331-371
- 8 Wilhelm A. Denervation of the wrist. Hefte Unfallheilkd 1965; 81: 109-114
- 9 Buck-Gramcko D. Denervation of the wrist joint. J Hand Surg Am 1977; 2 (01) 54-61
- 10 Gay A, Harbst K, Hansen DK, Laskowski ER, Berger RA, Kaufman KR. Effect of partial wrist denervation on wrist kinesthesia: wrist denervation does not impair proprioception. J Hand Surg Am 2011; 36 (11) 1774-1779
- 11 Fuchsberger T, Boesch CE, Tonagel F, Fischborn T, Schaller HE, Gonser P. Patient-rated long-term results after complete denervation of the wrist. J Plast Reconstr Aesthet Surg 2018; 71 (01) 57-61
- 12 Schweizer A, von Känel O, Kammer E, Meuli-Simmen C. Long-term follow-up evaluation of denervation of the wrist. J Hand Surg Am 2006; 31 (04) 559-564
- 13 Fukumoto K, Kojima T, Kinoshita Y, Koda M. An anatomic study of the innervation of the wrist joint and Wilhelm's technique for denervation. J Hand Surg Am 1993; 18 (03) 484-489
- 14 Foucher G, Da Silva JB, Ferreres A. Total denervation of the wrist. Apropos of 50 cases [in French]. Rev Chir Orthop Repar Appar Mot 1992; 78 (03) 186-190
- 15 Ehrl D, Erne HC, Broer PN, Metz C, Falter E. Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis. J Hand Surg Eur Vol 2016; 41 (09) 904-909
- 16 Milone MT, Klifto CS, Catalano III LW. Partial wrist denervation: the evidence behind a small fix for big problems. J Hand Surg Am 2018; 43 (03) 272-277