The Interest of Wrist Denervation in Managing Degenerative Wrists: A Study of 25 Cases

Background: Wrist denervation is a palliative intervention aimed at alleviating painful symptoms while preserving joint mobility. However, the outcomes of this procedure remain controversial. Objectives: The purpose of our study is to assess the long-term results of wrist denervation. Design & Methods: Our experience involved 25 denervations performed between 2009 and 2019. Retrospective evaluation of results focused on pain (visual analog scale), function (Quick Dash), joint ranges of motion, and radiological control. Results: Our patients were middle-aged men (average age: 44 years) and one woman (age: 47 years); 16 of them were manual laborers. The dominant side was affected in 20 cases. The conditions treated included sequelae of scaphoid nonunion in 16 cases, severe scapholunate ligament injury in 5 cases, distal radius fracture in 3 cases, and Kienböck's disease in 1 case. Our surgical technique involved three approaches: dorsal, dorso-radial, and dorso-ulnar, with excision of the posterior interosseous nerve, anterior interosseous nerve, and articular branches of the radial sensory nerve and dorsal cutaneous branch of the ulnar nerve. Two patients were lost to follow-up. The average follow-up period was 43 months. Pain, assessed using a visual analog scale, averaged 3 at rest and 5 during activity. There was no change in wrist joint ranges of motion. The average postoperative Quick Dash score was 22.24/100. Only 5 patients showed no improvement. Radiological findings remained stable in the majority of cases. Complications included transient paresthesias (2 cases), algodystrophy (2 cases), and cold intolerance (2 cases). Only 5 patients required reclassification. Conclusions: The typical indication is a chronically painful wrist in a patient retaining useful strength and ranges of motion. This experience confirms the expected outcomes of this surgery: pain relief and preservation of mobility, following a technically precise yet simple procedure with few notabl