title: Wrist denervation in isolation: a prospective outcome study with patient selection by wrist blockade.
abstract: Surgical wrist denervation involves division of the anterior and posterior interosseous nerves and articular branches of the superficial radial nerve. In this outcome study, 37 patients were individually assessed and deemed suitable for denervation surgery due to appreciable symptom resolution following a local anesthetic wrist block. At a mean of 18 months following denervation surgery, median activity pain scores had decreased by 60% (p < 0.001) from initial assessment levels, and more than three quarters (30/37) of patients reported continued improvement in their activity pain (p < 0.001). More than two thirds of patients had a satisfaction VAS of greater than 50, with less postoperative resting pain and a greater reduction in postoperative activity pain as the important predictors of patient satisfaction. Thirty-one out of the 37 patients had not represented to our department for revision wrist surgery by a mean of 10.3 years follow-up. We have found this procedure useful in ameliorating symptoms for some patients who would conventionally have required partial or total wrist fusions with greater residual functional limitation.
authors.affiliation: Pulvertaft Hand Centre, Royal Derby Hospital, Uttoxeter Road, DE22 3NE, UK. phil.storey@nhs.net
authors.forename: P A
authors.initials: PA
authors.lastname: Storey
authors.forename: T
authors.initials: T
authors.lastname: Lindau
authors.forename: V
authors.initials: V
authors.lastname: Jansen
authors.forename: S
authors.initials: S
authors.lastname: Woodbridge
authors.forename: L C
authors.initials: LC
authors.lastname: Bainbridge
authors.forename: F D
authors.initials: FD
authors.lastname: Burke
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D002348:Carpal Bones / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D003714:Denervation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005532:Foot Deformities, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006228:Hand Deformities, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D018579:Patient Selection; D011446:Prospective Studies; D013199:Stapes / Q000002:abnormalities; D013580:Synostosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013639:Tarsal Bones / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014955:Wrist Joint / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local