Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Clinical Outcomes and Cadaveric Study

Tuffaha, Sami H.; Quan, Amy; Hashemi, Shar; Parikh, Pranay M.; O’Brien-Coon, Devin M.; Broyles, Justin M.; Dellon, A. Lee; Lifchez, Scott D.

doi:10.1016/j.jhsa.2018.04.030

Cited by 38 publications

(16 citation statements)

References 26 publications

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“…Consequently, the role of physical therapy to evaluate and treat posture-related extremity pain is critical and physicians that treat pain should not hesitate to refer patients with pain to physical and/or occupational therapy. Additionally, joint denervation is one treatment option in the algorithm for the management of arthritic pain [14][15][16][17][18][19].…”

Section: Pain Definitions and Biologymentioning

confidence: 99%

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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Pain is a frequent cause of physician visits. Many physicians find these patients challenging because they often have complicated histories, emotional comorbidities, confusing examinations, difficult problems to fix, and the possibility of factitious complaints for attention or narcotic pain medications. As a result, many patients are lumped into the category of chronic, centralized pain and relegated to pain management. However, recent literature suggests that surgical management of carefully diagnosed generators of pain can greatly reduce patients' pain and narcotic requirements. This article reviews recent literature on surgical management of pain and four specific sources of chronic pain amenable to surgical treatment: painful neuroma, nerve compression, myofascial/ musculoskeletal pain, and complex regional pain syndrome type II.

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Section: Pain Definitions and Biologymentioning

confidence: 99%

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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“…It is about to offer a wider access to the TMC joint in its dorsal and volar aspect including the trapezium and metacarpal bases, ensuring complete dissection of all sensory branches. The Wagner approach [2,9,23] requires elevation of the thenar muscles and a circumferential "degloving" above the joint capsule, fully reaching branches from the lateral cutaneous nerve of the forearm and the median nerve, including the thenar branch and the palmar cutaneous branch.…”

Section: Discussionmentioning

confidence: 99%

Innervation of digital joints: an anatomical overview

et al. 2021

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Introduction The innervation of the digital joints as well as the anatomical relationships of the articular branches is present in this anatomical work to determine the technical feasibility of a selective and efficient denervation of the digital joints. Materials and methods A study of 40 distal interphalangeal (DIP), 40 proximal interphalangeal (PIP), 50 metacarpophalangeal (MCP), 10 interphalangeal (IP) of the thumb, and 10 trapezo-metacarpophalangeal (TMC) joints was performed on ten hands. Under magnification and a proper surgical approach, we collected the course, the source origin, the number of articular nerve branches, and their caliber. Results In total, 118 nerve branches arising from the proper palmar digital nerves were found on 10 DIP of each dissected long finger (n = 40). A total of 226 nerve branches were found on 10 PIPs of each long finger (n = 40), of which 204 branches (90.3%) had a palmar origin. Dorsal innervation was found for the ring and little finger, originating from the dorso-ulnar digital nerve. 212 branches were found on 10 MCP of long fingers (n = 40), including 87 branches of palmar origin (41.1%), 107 branches of dorsal origin (50.4%), and 18 branches of the motor branch of the ulnar nerve (8.5%). 42 articular branches directed to the TMC joint (n = 10) were found. 13 branches (31%) originated from the anterior sensory branch of the radial nerve, 13 branches (31%) originated from the lateral cutaneous nerve of the forearm, 5 branches (12%) originated from the palmar cutaneous branch of the median nerve, and 11 (26%) branches originated from the thenar branch of the median nerve. The involvement of the sensory anterior branch of the radial nerve was always present for the innervation of each TMC. Discussion and conclusion Our research shows that finger joints receive their primary innervation from small branches of the digital nerves with the exception of the MCP joint and the TMC joint. To obtain an efficient and a selective digital denervation for articular pain relief, it is necessary to plan the best surgical approach and it is crucial to recognize the articular nervous branch localization and source.

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“…Denervation of the TMJ has been shown to reduce pain in patients with TMJOA (Tuffaha et al., 2019). One may hypothesize that this is, in part, due to the removal of innervation to the synovial membrane, which stops the neurogenic inflammatory pattern found in our study.…”

Section: Discussionmentioning

confidence: 99%

Histopathological analysis of the synovium in trapeziometacarpal osteoarthritis

Rein

Okogbaa

Hagert

et al. 2019

J Hand Surg Eur Vol

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Dorsoradial and anterior oblique ligaments were harvested during surgery in 13 patients with symptomatic trapeziometacarpal osteoarthritis, which had been graded preoperatively by a modified Eaton-Littler radiographic grading. Ligaments, including the periligamentous synovium, were stained with S100 protein, neurotrophic receptor p75, protein gene product 9.5, calcitonin gene related peptide, acetylcholine, substance P, neuropeptide Y, noradrenaline, N-methyl-D-aspartate-receptor and Met/Leu-enkephalin. The synovium was classified as showing no, low-grade or high-grade synovitis. Free nerve endings had higher immunoreactivity for substance P than for N-methyl-D-aspartate-receptor, enkephalin and noradrenaline. The synovial stroma had less immunoreactivity for N-methyl-D-aspartate-receptor than for noradrenaline, substance P and calcitonin gene related peptide. There was no relation between the grade of osteoarthritis and the visual pain analogue scale, synovitis score, immunoreactivity of all antibodies and quantity of free nerve endings or blood vessels. Synovium in trapeziometacarpal joint osteoarthritis produces several neuromediators causing a polymodal neurogenic inflammation and which may serve as biomarkers for osteoarthritis or therapeutic targets.

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Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Clinical Outcomes and Cadaveric Study

Cited by 38 publications

References 26 publications

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Innervation of digital joints: an anatomical overview

Histopathological analysis of the synovium in trapeziometacarpal osteoarthritis

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