Wrist Denervation

Indications

Symptomatic arthritis in elderly patient with concurrent medical problems that preclude major wrist reconstruction
Patients of all ages with symptomatic arthritis who want an opportunity to reduce their wrist pain with minimal postoperative morbidity

Pitfall

Experience with wrist denervation has been primarily in patients with osteoarthritis. Wrist denervation as an isolated treatment is not recommended in patients with rheumatoid arthritis.

Preoperative Evaluation

Pain localized to the radiocarpal and midcarpal joints
Pain diminished with block of the posterior interosseous and anterior interosseous nerves

Figure 43-1

Technique

Dorsal midline incision centered two fingerbreadths proximal to radiocarpal joint (Fig. 43-1)
Open the fascia, proximal to the extensor retinaculum between the tendons and muscle bellies of the extensor pollicis longus and tendons of the fourth extensor compartment.
The posterior interosseous nerve (PIN) lies on the interosseous membrane (Fig. 43-2).
Separate the nerve from the contiguous posterior interosseous artery (PIA).
Resect a 1 cm segment of the nerve and cauterize the two ends.
Incise the interosseous membrane over a length of 2 cm.
The anterior interosseous nerve (AIN) lies directly anterior to the interosseous membrane (Fig. 43-3).
Separate the nerve from the contiguous anterior interosseous artery (AIA).
Resect a 1 cm segment of the nerve and cauterize the two ends.
Disrupt small dorsal cutaneous nerves to the wrist by sweeping a finger between the fascia and the subcutaneous tissues, radial, ulnar, and distal to the skin incision (Fig. 43-4).
Close skin and apply a soft dressing.