Abstract
Introduction
The management of chronic wrist pain is a challenging clinical problem. Wrist denervation aims to achieve an improvement in pain through selective neurotomy, irrespective of cause. Numerous authors have reported their experience and demonstrated a range of clinical outcomes. No studies to date have reliably identified patient populations in whom denervation surgery is most likely to succeed. We aimed to establish and investigate a new approach, combining local anaesthetic injections with a uniquely tailored functional assessment by a hand therapist, to act as a tool to identify individuals in whom surgical denervation is more likely to yield benefit.
Methods
We conducted a retrospective review of 17 patients who had undergone wrist denervation procedures following our method of pre-operative assessment and selection. Patients in whom denervation was combined with other diagnostic or therapeutic surgical procedures were excluded. Each patient underwent an initial assessment by a hand therapist in which pain and functional scores were recorded using the Patient Rated Wrist Evaluation (PRWE). Further unique assessments of function were made, tailored to the functional goals and requirements of each patient. Pain scores were measured for each task. Local anaesthetic injections were then administered around the nerves considered for neurotomy and the assessments were repeated. Patients who demonstrated clear improvements in pain and function underwent surgery. Post-operative assessments of pain and function were repeated.
Results
Results were analysed using the Wilcoxon signed ranks test. There was a statistically significant improvement in pain following wrist denervation surgery (p=0.06) as well as an improvement in function as measured on PRWE (p=0.01). Furthermore, the degree of improvement following local anesthetic injection correlated with the degree of improvement seen after surgery (p=0.06)
Conclusions
Regardless of underlying diagnosis, improvements in pain and function following our assessment and selection process correlated with improvements seen after denervation surgery.
