The 2003 Annual Meeting of OASYS_NEW

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Outcome Assessment of Wrist Denervation – a Review of 84 Patients

Sauerbier M, Tränkle M, Schachner M, and Germann G. Hand-, Plastic & Reconstructive Surgery; -Burn Center-, BG Trauma Center Ludwigshafen/University of Heidelberg, Ludwig-Guttmann-Str. 13, Ludwigshafen, Germany

Introduction: Denervation of the wrist joint was first performed by Wilhelm in 1959. The goal of denervation of the wrist is to reduce pain stemming from intraarticular pathology such as SNAC-/SLAC wrist, radiocarpal arthrosis or Kienböck`s disease by resection of peripheral nerves whose terminal fibers innervate the joint capsule. The purpose of this clinical retrospective study was to evaluate the functional outcomes of patients who underwent isolated wrist denervation as a palliative procedure. Methods: 145 patients were treated with a wrist denervation from 1993 to 2000. Of these, 84 were reexamined and included in the study. The mean follow-up time was 46 months. There were 60 males and 14 females, with an average age of 48,5 (19-74) years. The indication for wrist denervation was radiocarpal arthrosis in the majority of the cases. Pain was evaluated by a visual analogue scale (VAS 0-100). Grip strength and range of motion were measured with the Dexterä-System. Patients‘ daily activities and general quality of life were estimated with the DASH questionnaire. Results: 54 patients had pain relief after the operation. 18 patients reported complete pain relief under stress conditions. Pain was reduced from 69,1 preoperatively to 49,8 (28%) postoperatively under stress and remained unchanged (24,6) under resting conditions. The average duration of pain relief was 37 (6-91) months. Active range of motion for extension/flexion was 63% and for ulnar-/radialdeviation 57% of the contralateral wrist. Grip strength was 67% compared to the nonoperated wrist. The total DASH-score was 38 points. 8 patients underwent additional surgery including total wrist arthrodeses, four-corner-arthrodeses and other procedures. 31 patients were suffering from loss of sensation at the dorsal wrist side. 49 patients were “somewhat satisfied”, 9 “partially satisfied” and 22 patients were “not satisfied”. Discussion: Our data demonstrate that wrist denervation can be used as a palliative procedure for treating chronic wrist disorders. Pain relief was satisfactory in 64% of the patients and the duration of pain relief was acceptable as well as grip strength and ROM. The DASH-score performance confirms residual disability with this procedure. We recommend the use of wrist denervation for patients who are not suitable for prolonged reconvalescence and the difficulties of wrist salvage operations, reserving partial or total wrist fusions as the last line of defense.