Article

The goal of wrist denervation is to decrease pain at the wrist, whether caused by
an intra- or extra-articular problem or even when the reason for the pain is
unknown. It is an alternative to partial or total arthrodesis and proximal row
carpectomy. Our hypothesis was that wrist denervation with a two-incision
technique was a reliable and efficient way to treat painful degenerative wrists.
Thirty-three patients, 48years old on average, were included in this study.
Indications were scapholunate advanced collapse (SLAC) in 18 cases, scaphoid
nonunion advanced collapse (SNAC) in 10, distal radius fracture sequelae with
advanced radiocarpal osteoarthritis in 4, and post-traumatic ulnocarpal
impingement in 1 case. At 41 months' follow-up (12-161), there was a 75%
reduction in pain levels, decreasing from 7.1 to 1.8 on a visual analog scale
(VAS). There were no modifications related to wrist range of motion or grip
strength. The QuickDASH averaged 23 points (5 to 70). Radiographic evaluation
showed progression of intracarpal degeneration in 6 patients. All but 2 patients
returned to their previous work. Persistent dysesthesia was observed in 7
patients; it resolved in 3 cases and persisted in 4. One patient developed
complex regional pain syndrome (CRPS). A midcarpal arthrodesis with
scaphoidectomy was performed in one patient because of disabling pain 5months
after surgery. Wrist denervation with a two-incision technique for post-traumatic
osteoarthritis led to satisfactory results in 75% of cases with reduction in
pain, preservation of range of motion and grip strength. However, this technique
does not stop the progression of osteoarthritis. It can be discussed as a
therapeutic alternative to proximal row carpectomy or intracarpal arthrodesis to
treat degenerative painful wrists. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic
IV.
CI - Copyright (c) 2017. Published by Elsevier Masson SAS.

Langue : ANGLAIS