Wrist denervation of the posterior interosseous nerve through a volar approach: a new technique with anatomical considerations

Grechenig, Stephan; Lidder, Surjit; Dreu, Manuel; Dolcet, Claudia; Cooper, Lucy Marguerite; Feigl, Georg

doi:10.1007/s00276-016-1783-x

Cited by 8 publications

(10 citation statements)

References 13 publications

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“…On deep dissection to the anterior distal forearm, care must be taken not to damage branches of the AIN, especially when working around PQ. The AIN was shown to be located some distance from the RS, 6.67 cm (±0.92) and 5.5 cm (±0.6) as reported by Grechenig et al (2017) and Hinds et al (2015), respectively. However, during procedures involving mobilization of the PQ, the surgeon must be aware that branches of AIN may be located 1.7 cm distal from the distal PQ border (Hinds et al, 2015).…”

Section: Safe and At-risk Zones In The Anterior Approach To The Dista...mentioning

confidence: 75%

“…The mean anterior-posterior distance was 0.28 cm (±0.02) between the two nerves. Grechenig et al (2017) showed these nerves were closest to one another at 8 cm proximal to the RS and a mean 0.84 cm (±0.23) from the ulnar edge of the radius. Jariwala et al (2014) highlighted in their study the proximity of the last motor branch of the PIN to the ulnar head (4.7 cm ± 0.84) and showed the last motor branch of the PIN supplied the extensor indicis in 70% of cases and extensor pollicis longus (EPL) in 30%.…”

Section: Posterior Interosseous Nervementioning

confidence: 93%

“…The PIN was consistently found in the 4th extensor compartment (Jariwala et al, 2014), and the surgeon must also be aware of its proximity to the AIN. The point at which the PIN and AIN were in closest proximity to each other was 8 cm proximal to the RS, on the ulnar side of the forearm (Grechenig et al, 2017).…”

Section: Thompson's Approach To the Distal Forearmmentioning

confidence: 99%

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Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Bridgwater,

Mertz,

Brassett

et al. 2023

Clinical Anatomy

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Three commonly used approaches to the forearm in orthopedic surgery are Henry's, Thompson's, and the ulnar approach, each of which has the potential to cause injury to nerves around the wrist. Preserving these nerves is important to prevent complications such as neuroma formation and motor and sensory changes to the hand. We conducted a review of the literature to assess the nerves at risk and whether ‘safe zones’ exist to avoid these nerves. An independent reviewer conducted searches in Embase and MEDLINE of the literature from 2010 to 2020. A total of 68 papers were identified, with 18 articles being included in the review. Multiple nerves were identified as being at risk for each of the approaches described. In the anterior approach, the palmar cutaneous branch of the median nerve (PCBMN) is most at risk of injury. An incision immediately radial to the flexor carpi radialis (FCR) or directly over the FCR is most likely to avoid injury to both superficial branch of the radial nerve (SBRN) and PCBMN. With Thompson's approach, the safest zone for an incision is directly over or slightly radial to Lister's tubercle to avoid injury to SBRN and lateral cutaneous nerve of the forearm. For the ulnar approach, a safe zone was shown to be on the ulnar side of the wrist around the ulnar styloid (US) when the forearm was in supination or a neutral position to avoid injury to the dorsal branch of the ulna nerve (DBUN). Care must be taken around the US due to the density of nerves and the proximity of the last motor branch of the posterior interosseous nerve to the ulnar head. This review highlighted the proximity of nerves to the three most common surgical incisions used to access the forearm. In addition, anatomical variations may exist, and each of the nerves identified as being at risk has multiple branches. Both factors increase the potential of intraoperative damage if the anatomy is not properly understood. The surgeon must adhere carefully to the established approaches to the wrist and distal forearm to minimize damage to nerves and optimize surgical outcomes for the patient.

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Section: Safe and At-risk Zones In The Anterior Approach To The Dista...mentioning

confidence: 75%

Section: Posterior Interosseous Nervementioning

confidence: 93%

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Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Bridgwater,

Mertz,

Brassett

et al. 2023

Clinical Anatomy

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“…It is unclear whether this procedure improves outcomes because of denervation of the radiocarpal joint and helps resolve other pathology, or PIN neurectomy denervates the DRUJ. [26][27][28] It is also possible the PIN neurectomy is a surrogate for other technical factors that are unable to be captured in the data available.…”

Section: Discussionmentioning

confidence: 99%

Hemiresection Interposition Arthroplasty of the Distal Radioulnar Joint: A Long-term Outcome Study

Nawijn

Verhiel

Jupiter

et al. 2019

Hand (New York, N,Y.)

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Background: The aim of this study was to assess factors associated with long-term patient-reported functional, pain, and satisfaction scores in patients who underwent (Bowers) hemiresection interposition technique (HIT) arthroplasty of the distal radioulnar joint (DRUJ). The secondary aims were to determine the complication and reoperation rates. Methods: A retrospective study with long-term follow-up of patients undergoing HIT arthroplasty was performed. Demographic, disease, and treatment characteristics were collected for the 66 included patients. Thirty-one patients completed all surveys, which were the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH), our custom-made HIT arthroplasty questionnaire, Numeric Rating Scale (NRS) for pain, and NRS for satisfaction. The mean interval between surgery and follow-up by means of questionnaires was 8.6 ± 3.4 years. Results: The mean QuickDASH score was 31.0 ± 20.2. The mean score of the HIT arthroplasty questionnaire was 2 ± 2. The median NRS for pain was 1 (interquartile range [IQR], 0-3), and the median NRS for satisfaction was 9 (IQR, 8-10). The complication rate and reoperation rate were 14% and 8%, respectively. Conclusion: Overall, patients expressed satisfaction with HIT arthroplasty, despite a mean QuickDASH score of 31.0. In our cohort, patients with inflammatory arthritis had higher satisfaction and lower pain scores. Patients who had prior trauma, prior surgery, or DRUJ subluxation are generally less satisfied. Men, older patients, and posttraumatic patients had higher long-term pain scores; however, posterior interosseous nerve neurectomy is associated with improved pain scores. Our findings support the use of HIT arthroplasty in patients with inflammatory arthritis.

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“…Denervation techniques of the wrist have been modified over the years from Wilhelm’s ‘complete’ denervation in 1959 (Wilhelm, 2001) to less invasive ‘partial’ denervation using only a single incision (Berger, 1998; Grechenig et al., 2017). Partial denervation focuses on specific articular nerves, especially the anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN).…”

Section: Introductionmentioning

confidence: 99%

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

Chin

Engelsman

Gulik

et al. 2019

J Hand Surg Eur Vol

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Selective denervation of sensory nerve branches to the wrist is a palliative surgical treatment option for patients with chronic wrist pain when preserving the range of motion and function is preferred. Treatment varies from partial isolated denervation of the posterior interosseous nerve to extensive ‘complete’ denervations. This study aimed to provide an overview of the literature regarding treatment outcomes in the domains of pain, grip strength, patient satisfaction and return to work. MEDLINE (PubMed), EMBASE and Cochrane databases were systematically searched and identified 993 studies, of which 12 were eligible for analysis. Denervation resulted in high ‘return to work’ rates (up to 94%), patient satisfaction (up to 92%), increased grip strength (7%–64%) and improved average pain scores (36%–92%). Treatment outcomes of both partial and complete denervations were favourable; however, variations in outcomes suggest the need for improving evidence regarding surgical technique and nerve identification.

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Wrist denervation of the posterior interosseous nerve through a volar approach: a new technique with anatomical considerations

Abstract: This study shows the local anatomy of the PIN, allowing denervation via a volar approach.

Cited by 8 publications

References 13 publications

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Hemiresection Interposition Arthroplasty of the Distal Radioulnar Joint: A Long-term Outcome Study

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

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