Partial Wrist Denervation with Wide-Awake Local Anesthesia No Tourniquet Technique

Partial wrist denervation (PWD) is a palliative treatment option for some patients with chronic wrist pain from wrist arthrosis, carpal osteonecrosis, or other wrist disorders. In our experience, patients with wrist pain resistant to conservative treatment who have retained functional wrist motion are good candidates for PWD if lidocaine block of the posterior interosseous nerve (PIN) and the anterior interosseous nerve (AIN) produces at least 50% pain relief. PWD may be performed on an outpatient basis using wide-awake local anesthesia no tourniquet (WALANT) technique. The dorsal wrist and distal forearm are anesthetized using 1% lidocaine with 1:100,000 epinephrine by tumescent technique. Anesthetic and vasoconstrictive effects are realized about 30 minutes after the injection obviating the need for tourniquet control. A short longitudinal incision is used to approach the fourth dorsal compartment wherein the PIN is identified and segmentally resected. After the interosseous membrane is divided distally, the terminal AIN is also identified and segmentally resected. No postoperative immobilization is required. An illustrative case of stage III scapholunate advanced collapse wrist managed with this method is provided. PWD may be safely performed in an ambulatory surgery setting using the innovative WALANT technique with the expectation of few complications, high patient satisfaction, and reduced procedure cost.