Selective denervation of the wrist for chronic pain: a systematic literature review

Chin, Kenneth W.; Engelsman, Anton F.; Gulik, Thomas M. van; Strackee, Simon D.

doi:10.1177/1753193419886777

Cited by 18 publications

(17 citation statements)

References 30 publications

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“…Among the 81 patients, 59 were reviewed with a minimum of 5 years of follow-up, 4 died, and 18 (22%) could not be reviewed after 5 years and were considered lost to followup. The clinical and radiological analyses were performed on 59 patients (63 procedures) with a mean follow-up of 7.0 AE 1.5 years (5)(6)(7)(8)(9)(10)(11). Comparison of data at 2 years and at the last follow-up was also performed on these same patients.…”

Section: Populationmentioning

confidence: 99%

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Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

et al. 2021

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Background Amandys is a pyrocarbon interposition implant used as a therapeutic alternative to total wrist fusion (TWF) or total wrist arthroplasty (TWA) in painful and disabling extensive destruction of the wrist. Objective To review mid-term outcomes in a continuous prospective series of patients who underwent wrist arthroplasty Amandys with a minimum follow-up of 5 years. Methods Clinical evaluation included a satisfaction survey, pain, two functional scores, the short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Rated Wrist Evaluation (PRWE), active wrist mobility, and grip strength compared with the contralateral side. Radiological evaluation was used to detect implant subsidence, carpal migration, bone lysis, or implant malposition. All per- and postoperative complications were collected. Results Fifty-nine patients (63 procedures) were evaluated with a mean follow-up of 7 years; 57% of the patients were males, and the mean age was 58 years. Among the patients, 90% were satisfied or very satisfied. Pain was significantly improved, with a gain of 4/10 (p < 0.001). Functional outcomes also improved between the second and fifth year of follow-up. Active mobility was preserved and grip strength was significantly improved by 7 kg (p < 0.001). No implant subsidence or carpal migration was observed. Ten patients (11.9%) underwent revision surgery for conflict (1%), rotation (6%), or implant dislocation (5%). All complications and revisions occurred early with no new events after 1 year of follow-up. Discussion Mid-term clinical and radiological outcomes were stable with improvement of functional scores. The survival rate was comparable to that reported for TWF with conserved mobility. We report fewer complications compared with those reported for TWA or TWF. Early instability of the implant was the main etiology of the revisions. Repositioning of the implant was successful. No conversion to TWA or TWF was necessary. Conclusions Mid-term outcomes of the Amandys implants were encouraging. Patients conserved good wrist motion with improved strength and functional scores. The implant was well tolerated. Functional outcomes continue to improve with the follow-up. The survival rate remains stable after 2 years. The level of evidence of this study is IV (therapeutic case series).

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Section: Populationmentioning

confidence: 99%

“…Denervation only temporarily improves pain without affecting joint mobility, grip strength, or radiological changes. [4][5][6][7] Studies on TWF and especially TWA have shown a decline in long-term survival, even when the preliminary results were favorable. Amandys is a pyrocarbon implant used as an interposition arthroplasty.…”

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confidence: 99%

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

et al. 2021

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“…De Kesel et al (2012) argued that resection of articular branches lead necessarily to a sensory or motor deficit. As is the case with denervation for chronic pain about the wrist (Chin et al, 2019), we posit that neurologic deficits can be avoided via selective resection of the nociceptive articular branches to the elbow joint.…”

Section: Lessons Learnedmentioning

confidence: 99%

Sensory innervation of the human elbow joint and surgical considerations

et al. 2020

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Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty‐one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano‐receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.

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“…3 SWD can be performed by doing a posterior interosseous nerve (PIN) neurectomy or/and an anterior interosseous nerve (AIN) neurectomy. 4 , 5 One common complication of SWD is neuroma formation, which is an “inevitable and biologic response of the proximal stump after it has been divided in situations where regenerating axons are impeded from re-entering the distal stump.” 6 Several techniques have been suggested in the literature to prevent neuroma formation, including implantation of the nerve in a surrounding muscle or vein, neurorrhaphy, nerve stripping or silicone rubber capping. 7 Despite the existence of several approaches, no technique is recognized as the gold standard in the management of terminal neuromas.…”

Section: Introductionmentioning

confidence: 99%

Neurorrhaphy of anterior and posterior interosseous nerves in the prevention of neuroma following a radical neurectomy: A case report

Sioufi

Alam

Bédard

et al. 2022

SAGE Open Medical Case Reports

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Selective wrist denervation is a surgical technique frequently performed for the treatment of chronic wrist pain. While this technique is often effective in pain reduction, it is still associated with certain complications such as pain recurrence secondary to neuroma formation. We present a case report that details the clinical case of a young yoga teacher suffering from debilitating chronic wrist pain, refractory to conservative treatments. We describe a new surgical technique for the treatment of chronic wrist pain: posterior interosseous nerve and anterior interosseous nerve neurectomy followed by neurorrhaphy in preventing neuroma formation. Post-operatively, the patient’s wrist pain continuously improved and completely resolved without any signs of recurrence. Posterior interosseous nerve and anterior interosseous nerve neurectomy followed by an end-to-end neurorrhaphy can be used as an effective novel surgical technique in the management of chronic wrist pain with prevention of neuroma formation.

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Selective denervation of the wrist for chronic pain: a systematic literature review

Cited by 18 publications

References 30 publications

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

Medium-Term Outcomes for Amandys Implant: A 5-Year Minimum Follow-Up of 63 Cases

Sensory innervation of the human elbow joint and surgical considerations

Neurorrhaphy of anterior and posterior interosseous nerves in the prevention of neuroma following a radical neurectomy: A case report

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