[Joint denervation, a simple response to complex problems in hand surgery].
OBJECTIVE
In patients with preserved mobility and stability a painful joint remains a difficult problem, especially in elderly patients. All operations, including intracarpal arthrodesis, reduce an already limited mobility, require prolonged immobilization and have a high rate of complications. Denervation could be proposed in such cases.


METHODS
In our study denervation was performed on 132 wrists, 36 first carpo-metacarpal joints and 32 proximal inter-phalangeal joints.


RESULTS
We have been disappointed in the past by partial wrist denervations. Fifty cases of complete and isolated wrist denervation were reviewed with a mean 5-year followup. Strength and mobility were only marginally improved but pain was decreased by a mean 75% (on a visual analog scale) in 74% of patients. At the proximal inter-phalangeal joint level, the mean pain improvement was 88% in 85% of patients. At the first carpo-metacarpal joint level, results of denervation were less predictable and the mean pain improvement was 67% in 81% of patients, with a mean 17-month follow-up.


CONCLUSIONS
Joint denervation is a simple but precise operation performed under local anesthesia and on an outpatient basis. It provides good results in elderly patients, with few complications.
Foucher
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G
Long Pretz
P
P
Erhard
L
L
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000209:etiology / Q000601:surgery*; D003714:Denervation; D005260:Female; D005384:Finger Joint / Q000294:innervation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000294:innervation*; D008875:Middle Aged; D010147:Pain Measurement; D012086:Reoperation; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery*