Abstract
Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC)
are common patterns of wrist arthritis, and surgical treatment options include partial
and total wrist arthrodesis and wrist denervation, which maintains the current anatomy
while relieving pain.
Introduction The purpose of this study is to elucidate current practices within the hand surgery
community with respect to the use of anterior interosseous nerve/posterior interosseous
nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists.
Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American
Society for Surgery of the Hand (ASSH) listserv. The survey collected information
on conservative and operative management, indications, complications, diagnostic block,
and coding of wrist denervation.
Results In total, 298 answered the survey. 46.3% (N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7%
(N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage.
AIN and PIN combined denervation was the most common standalone procedure (N = 185, 62.1%). Surgeons were more likely to offer the procedure (N = 133, 55.4%) if motion preservation had to be maximized (N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception (N = 224, 84.2%) or diminished protective reflex (N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never
performing a diagnostic block prior to denervation.
Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain.
There is a wide range of treatment for different stages of disease. Further investigation
is required to identify ideal candidates and evaluate long-term outcomes.
Keywords
SLAC - SNAC - wrist - denervation - arthritis
