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Deglmann CJ. [Osteoarthritis of the wrist]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:463-476. [PMID: 38789591 PMCID: PMC11143053 DOI: 10.1007/s00132-024-04502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/26/2024]
Abstract
The term osteoarthritis (OA) of the wrist can be used as an umbrella term for various, often independent areas of OA, as the wrist is made up of several joints. Radiocarpal OA often occurs after untreated ligament injuries, incorrectly healed bone fractures in the carpus or after radius fractures involving the joint. A typical sequence of propagation is known for radiocarpal OA following scapholunate (SL) insufficiency or scaphoid pseudarthrosis. Other causes include inflammation, crystal deposits or bone necrosis. Ulnocarpal arthrosis occurs posttraumatically or primarily when there are differences in levels between the ulna and radius. When treating wrist arthrosis, after conservative measures have been exhausted a surgical procedure should be chosen that enables the best possible load-bearing and residual mobility, considering the surgical risks and individual requirements. During salvage operations, the defective cartilage areas are either fused directly or eliminated using appropriate diverting partial fusions and resection arthroplasty. An accurate analysis of the affected zones is crucial for selecting an appropriate intervention.
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Affiliation(s)
- C J Deglmann
- MünchenHand - Privatpraxis für Hand- und Handgelenkchirurgie, Marienplatz 21, 80333, München, Deutschland.
- Deutsches Zentrum für Obere Extremität, Effnerstr. 38, 81925, München, Deutschland.
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Rath R, Haerle M, Stollberg C, Herrmann S, Lampert F. Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients. HAND SURGERY & REHABILITATION 2023; 42:51-55. [PMID: 36436810 DOI: 10.1016/j.hansur.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/30/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. Between 2006 and 2018, 46 patients underwent the procedure in our clinic and were included in this retrospective study. Pain, strength, range of motion, DASH score, complications and overall satisfaction were determined. Assessment showed a significant decrease in pain and excellent physical function at a median 5 years' follow-up. Twelve patients needed secondary surgery due to persistent pain. Overall, 28 of the 46 patients were satisfied with the results of the denervation. Even though the results of CMC denervation are poorer than with simple trapeziectomy, considerable pain relief can be achieved in selected young, physically active patients by exclusively soft-tissue surgery, conserving the biomechanical properties of the joint. In case of failure of the procedure, all other options remain available.
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Affiliation(s)
- R Rath
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Hand, Plastic and Aesthetic Surgery, Klinikum Bad Cannstatt, Prießnitzweg 24, 70374 Stuttgart, Germany.
| | - M Haerle
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
| | - C Stollberg
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Plastic and Aesthetic Surgery, Pflugfelder Straße 22, 71636 Ludwigsburg, Germany.
| | - S Herrmann
- Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - F Lampert
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Department of Plastic and Hand Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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Catapano J, Higgins JP. An Algorithmic Approach to the Treatment of Kienböck Disease. Hand Clin 2022; 38:417-424. [PMID: 36244709 DOI: 10.1016/j.hcl.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The algorithm and rationale described is a reflection of our own surgical experience for this challenging disorder and can be compared with other publications. Our algorithm has evolved from treatment of a large volume of patients with Kienböck disease in a referral practice. However, it is limited to the management that we have found logical, effective, and within our scope of experience. The treatment guidelines for our specialty as a whole will evolve as our understanding of the etiology and our ability to quantify efficacy improves.
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Affiliation(s)
- Joseph Catapano
- Division of Plastic and Reconstructive Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly Wing, Room 4-072, Toronto, ON M5B 1W8, Canada
| | - James P Higgins
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, JPB #200, Baltimore, MD 21218, USA.
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Anatomical Study of the Innervation of Triangular Fibrocartilage Complex and Distal Radioulnar and Radiocarpal Joints: Implications for Denervation. J Hand Surg Am 2022; 47:843-854. [PMID: 35870958 DOI: 10.1016/j.jhsa.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/18/2022] [Accepted: 05/05/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Open and percutaneous denervation is an emerging technique for joint pain. This study investigated the course and distribution of the articular branches innervating the triangular fibrocartilage complex (TFCC), distal radioulnar joint (DRUJ), and radiocarpal joint (RCJ) relative to bony and soft tissue landmarks to guide wrist denervation procedures. METHODS Fourteen formalin-embalmed specimens were serially dissected to expose the origin, course, and distribution of articular branches innervating the TFCC, DRUJ, and RCJ. Bony and soft tissue landmarks to localize each articular branch were documented and visualized on a 3-dimensional reconstruction of the bones of the distal forearm and hand. RESULTS The TFCC was innervated by articular branches from the posterior interosseus nerve (10 of 14 specimens), dorsal cutaneous branch of the ulnar nerve (14 of 14 specimens), palmar cutaneous branch of the ulnar nerve (12 of 14 specimens), and medial antebrachial cutaneous nerve (9 of 14 specimens). The DRUJ was innervated by the posterior interosseus nerve (9 of 14 specimens) and anterior interosseus nerve (14 of 14 specimens). The RCJ was innervated by the posterior interosseus nerve (14 of 14 specimens), superficial branch of the radial nerve (5 of 14 specimens), lateral antebrachial cutaneous nerve (14 of 14 specimens), and palmar cutaneous branch of the median nerve (10 of 14 specimens). CONCLUSIONS Multiple nerves were found to innervate the TFCC, DRUJ, and RCJ. The relationship of anatomical landmarks to specific articular branches supplying the TFCC, DRUJ, and RCJ can inform selective denervation procedures based on the structural origin of pain. CLINICAL RELEVANCE The detailed documentation of the spatial relationship of the nerve supply to the wrist provides clinicians with the anatomical basis to optimize current, and develop new denervation protocols to manage chronic wrist pain.
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Denervation of the Joints of the Hand and Wrist: Surgical Techniques and a Systematic Review with Meta-Analysis. Plast Reconstr Surg 2021; 148:959e-972e. [PMID: 34847117 DOI: 10.1097/prs.0000000000008517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Joint denervation of the wrist, basal joint of the thumb, and the finger is an option for patients with chronic pain. Compared with other surgical treatment options, function is preserved and the rehabilitation time is limited. A systematic review and meta-analysis were performed for each joint to determine whether the choice of technique and choice of denervation of specific articular sensory branches lead to a different outcome. METHODS Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed publisher, Cochrane, and Google Scholar database searches yielded 17 studies with reported outcome on denervation of the wrist, eight on the basal joint of the thumb, and five on finger joints. RESULTS Overall, the level of evidence was low; only two studies included a control group, and none was randomized. Meta-analysis for pain showed a 3.3 decrease in visual analogue scale score for wrist pain. No difference was found between techniques (total versus partial denervation), nor did different approaches influence outcome. The first carpometacarpal joint showed a decrease for visual analogue scale score for pain of 5.4. Patient satisfaction with the treatment result was 83 percent and 82 percent, respectively. Reported pain in finger joints decreased 96 percent in the metacarpophalangeal joints, 81 percent in the proximal interphalangeal joint, and 100 percent in the distal interphalangeal joint. The only reported case in the metacarpophalangeal joint of the thumb reported an increase of 37 percent. CONCLUSIONS Only denervation of the metacarpophalangeal joint of the thumb reported an increase in pain; however, this was a single patient. Wrist and first carpometacarpal joint and finger joint denervation have a high satisfaction rate and decrease the pain. There was no difference between techniques.
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Pomares G, Lallemand B. Is there still a place for denervation in the treatment of osteoarthritis of the wrist and hand? Orthop Traumatol Surg Res 2021; 107:102986. [PMID: 34118475 DOI: 10.1016/j.otsr.2021.102986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Germain Pomares
- Institut Européen de la Main, Hôpital Kirchberg, 9, rue Edward Steichen, 2540 Luxembourg, Luxembourg
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Dellestable A, Cheval D, Kerfant N, Stindel E, Le Nen D, Letissier H. Does total wrist denervation give reliable long-term results? Survival curve with an average follow-up of 8.2 years. Orthop Traumatol Surg Res 2021; 107:102967. [PMID: 34033920 DOI: 10.1016/j.otsr.2021.102967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pain is the main reason why patients consult for degenerative and posttraumatic wrist conditions. While the many surgical techniques make choosing the appropriate procedure difficult, total wrist denervation, which has an "analgesic" aim, remains an accessible therapeutic solution to treat this symptomatology. Nevertheless, long-term results remain controversial, and few studies have focused on the survival of this procedure. HYPOTHESIS Total wrist denervation provides lasting pain relief. PATIENTS AND METHODS This was a single center, single operator (DLN), retrospective observational study. We analyzed 63 wrists. The mean age at the time of the procedure was 53.7 years. We verified the primary endpoint for survival, which included no further analgesic procedures and no significant residual pain (NRS≤3). Patient satisfaction and the quality of the wrist function were also assessed. RESULTS The mean follow-up was 8.2 years. Some of the patients (12.7%) did not respond to treatment. We reported 1 neuroma of the superficial sensory branch of the radial nerve, 2 CRPS and 11 revision surgeries. We observed that the treatment became less effective over time. The median survival was 8.8 years. The survival rate of the procedure fell to 13.5% at the last follow-up. The mean residual pain was 3.4 on a numerical rating scale and the mean DASH score was 23.5. The mean satisfaction level, on a scale from 0 to 10, was 7.3 and most patients (79.6%) would undergo this procedure again. DISCUSSION Survival of the total wrist denervation at the last follow-up was low in our study. Even though the treatment became less effective over time, the quality of the wrist function remained satisfactory and similar to the different studies previously published on the subject. There were very few complications and revisions. CONCLUSION Total wrist denervation therefore remains an interesting surgical solution for patients with chronic wrist pain as it preserves mobility. LEVEL OF EVIDENCE IV; Single center, single operator retrospective observational study.
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Affiliation(s)
- Arthur Dellestable
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
| | - Damien Cheval
- Service de chirurgie orthopédique et traumatologique, avenue Yves Thépot, Centre Hospitalier De Cornouaille, 29107 Quimper, France
| | - Nathalie Kerfant
- LaTIM, INSERM, UMR 1101, SFR IBSAM, Avenue Foch, 29200 Brest, France; Université de Bretagne Occidentale, UBO, Brest, 29200 France; Service de Chirurgie Plastique et Reconstructrice, Hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
| | - Eric Stindel
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France; LaTIM, INSERM, UMR 1101, SFR IBSAM, Avenue Foch, 29200 Brest, France; Université de Bretagne Occidentale, UBO, Brest, 29200 France
| | - Dominique Le Nen
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France; Université de Bretagne Occidentale, UBO, Brest, 29200 France
| | - Hoel Letissier
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France; LaTIM, INSERM, UMR 1101, SFR IBSAM, Avenue Foch, 29200 Brest, France; Université de Bretagne Occidentale, UBO, Brest, 29200 France.
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Smeraglia F, Basso M, Famiglietti G, Eckersley R, Bernasconi A, Balato G. Partial wrist denervation versus total wrist denervation: A systematic review of the literature. HAND SURGERY & REHABILITATION 2020; 39:487-491. [DOI: 10.1016/j.hansur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
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Kadhum M, Riley N, Furniss D. Is partial wrist denervation beneficial in chronic wrist pain? A systematic review. J Plast Reconstr Aesthet Surg 2020; 73:1790-1800. [DOI: 10.1016/j.bjps.2020.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
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Rein S, Winter J, Kremer T, Siemers F, Range U, Euchner N. Evaluation of proprioception in denervated and healthy wrist joints. J Hand Surg Eur Vol 2020; 45:408-413. [PMID: 31930922 DOI: 10.1177/1753193419897192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We recruited 25 patients after complete wrist denervation and 60 healthy adults to investigate conscious and unconscious proprioception of the wrist. Ipsi- and contralateral joint-position sense, force sense, and wrist reflexes were measured. The latter were triggered by a trapdoor, recording electromyographic signals from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles. No significant differences were found for joint position sense, force sense, and wrist reflexes between both groups, except for reflex time of the flexor carpi ulnaris after denervation of the left wrist as compared with the left flexor carpi ulnaris in controls or in right operated wrists. At a mean follow-up of 32 months (range 8 to 133), we found no proprioceptive deficit of the conscious proprioceptive qualities of joint position sense, force sense, and the unconscious proprioceptive neuromuscular control of wrist reflex time for most muscles after complete wrist denervation. We conclude from this study that complete wrist denervation does not affect the proprioceptive senses of joint position, force sense, and reflex time of the wrist.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| | - Jochen Winter
- Department of Plastic, Aesthetic and Hand Surgery, Hospital Dessau, Dessau-Roßlau, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ursula Range
- Institute of Medical Informatics and Biometry, Medical Faculty of Technical University Dresden, Dresden, Germany
| | - Nane Euchner
- Department of General, Visceral and Vascular Surgery, Hospital Vivantes Spandau, Berlin, Germany
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Chin KWTK, Engelsman AF, van Gulik TM, Strackee SD. Selective denervation of the wrist for chronic pain: a systematic literature review. J Hand Surg Eur Vol 2020; 45:265-272. [PMID: 31744376 DOI: 10.1177/1753193419886777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- Kenneth W T K Chin
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton F Engelsman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Total wrist denervation: Retrospective study of 39 wrists with 56 months' follow-up. Orthop Traumatol Surg Res 2019; 105:1607-1610. [PMID: 31495724 DOI: 10.1016/j.otsr.2019.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/14/2019] [Accepted: 04/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective of this study was to analyze patient satisfaction after total wrist denervation. HYPOTHESIS Total wrist denervation provides reliable and durable results. MATERIAL AND METHOD A single-center multi-surgeon retrospective study included a cohort of 39 wrists. Mean age was 58 years. The dominant side was operated on in two-thirds of cases. SLAC wrist and SNAC wrist accounted for 41% of etiologies. All patients were seen again in consultation and were evaluated for pain, strength, mobility and limb function. Failure was defined as any reoperation. RESULTS Mean follow-up was 56 months, with no loss to follow-up. Pain improved in 79.5% of cases. Median DASH score was 27.27. Strength on Jamar® dynamometer improved from 60% to 75% compared to the contralateral side (p=0.012). Range of motion improved by 5° (p=0.052). At last follow-up, 31% of patients showed aggravation of radiological osteoarthritis. There were 4 revision procedures (total wrist fusion), and 4 complications. DISCUSSION The present results were comparable to those in the literature in terms of satisfaction, functional scores and number of complications and revision procedures. Total wrist denervation is a reliable and reproducible surgical technique in terms of pain relief preservation of function in painful osteoarthritic wrists. It thus has an essential place in the therapeutic algorithm of patients presenting with chronic pain in a wrist that is still mobile, whatever the initial etiology. LEVEL OF EVIDENCE IV, Retrospective cohort.
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Pilny J, Slodicka R, Hajek P, Horackova K. Selective Carpus Denervation - One of Treatment Options of Madelung Deformity. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:497-500. [PMID: 31533161 DOI: 10.1055/a-0977-3657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Case presentation of 7 years follow up of female patient with wrist arthritis caused by Madelung deformity. As causal treatment remains unknown, the pain reduction by means of selective wrist denervation is one possible option.
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Affiliation(s)
- Jaroslav Pilny
- Orthopädische Chirurgie, Krankenhaus Nove Mesto na Morave, Tschechien
| | | | - Petr Hajek
- Anatomisches Institut, Medizinische Fakultät der Karls-Universität, Hradec Králové, Tschechien
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Abstract
Wrist denervation is a safe and effective procedure for the treatment of chronic wrist pain that can delay or eliminate the need for salvage or anatomically distorting procedure, such as proximal row carpectomy. The traditionally more extensive wrist denervation has evolved to procedures requiring fewer incisions. Efficacy of this procedure is corroborated by multiple publications either as a stand-alone procedure or as an adjunct to other procedures. This review provides an update on the status of wrist denervation.
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Affiliation(s)
- Chia H Wu
- New York Presbyterian-Columbia University Medical Center, 622 West, 168th Street PH 11-1119, New York City, NY 10032, USA
| | - Robert J Strauch
- New York Presbyterian-Columbia University Medical Center, 622 West, 168th Street PH 11-1119, New York City, NY 10032, USA.
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Abdelaziz AM, Aldahshan W, El-Sherief FAH, Wahd YESH, Soliman HAG. Posterior Interosseous Neurectomy Alternative for Treating Chronic Wrist Pain. J Wrist Surg 2019; 8:198-201. [PMID: 31192040 PMCID: PMC6546496 DOI: 10.1055/s-0039-1677740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
Background Wrist denervation is one of the several available options for treating chronic wrist pain; partial wrist denervation performed through a single dorsal incision by resecting the distal posterior interosseous nerve provides good outcomes. Questions/Purposes This study evaluated the results of posterior interosseous neurectomy (PIN) in patients with chronic wrist pain secondary to scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC). Methods In total, 30 wrists obtained from 28 patients (25 males, 3 females) were assessed. The dominant hands of 25 (right-handed) patients, nondominant hands of 5, and both hands of 2 were considered. The average age at the time of surgery was 35 (range: 19-50) years, and the average follow-up duration was 18 (range: 12-30) months. Fifteen and 13 patients had wrists with SNAC and SLAC, respectively, and all of those underwent PIN performed through the dorsal approach. The pre- and postoperative range of motion, grip strength, and pain relief percentage were recorded for all the 30 wrists. Results The average postoperative Disabilities of the Arm, Shoulder and Hand score was 30 (range: 20-80), and the difference between the pre- and postoperative scores was statistically significant. Ninety percent of the patients were satisfied with the results of PIN and reported improvement in grip strength and pain relief. Conclusions Thus, PIN may be an effective surgical technique for wrist reconstruction. Clinical Relevance To help patients challenge pain and maintain their wrist joint range of motion.
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Affiliation(s)
- Ashraf M. Abdelaziz
- Department of Orthopedics and Traumatology, Alzhraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Wael Aldahshan
- Department of Orthopedics and Traumatology, Alzhraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Faisal Ahmed Hashem El-Sherief
- Department of Orthopedics and Traumatology, Alzhraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Yaser El Sayed Hassan Wahd
- Department of Orthopedics and Traumatology, Alzhraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hany Abdel Gawwad Soliman
- Department of Orthopedics and Traumatology, Alzhraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Pastrana MJ, Zaidenberg EE, Palumbo D, Cesca FJ, Zaidenberg CR. Innervation of the Proximal Interphalangeal Joint: An Anatomical Study. J Hand Surg Am 2019; 44:422.e1-422.e5. [PMID: 30172449 DOI: 10.1016/j.jhsa.2018.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the innervation of the proximal interphalangeal (PIP) joint of the fingers as well as the anatomical relations of the articular branches. METHODS In this anatomical study, 52 fresh-frozen index, long, ring, and little fingers of 6 male and 4 female cadavers were dissected after injection of a colored latex composite. The anatomical dissections were performed under ×3.5 and ×6.0 magnifications. The numbers of articular nerve branches that penetrated the PIP joint on both sides of the fingers were quantified and patterns of innervation were established. We also measured the origin of the branches regarding the PIP articular line, the angle of emergence, and the diameter of the nerves. RESULTS The PIP joint was innervated by one articular branch of the proper palmar digital nerve at each side of the finger (pattern 1). Less frequently, an additional distal branch from the same proper palmar digital nerve was found (pattern 2). Dorsal articular branches were identified innervating only the little finger. CONCLUSIONS The findings suggest that PIP joints of the fingers have a consistent articular nerve anatomy predominantly provided at the palmar aspect of the joint. These findings provide an anatomical basis for procedures to denervate the PIP joint. CLINICAL RELEVANCE An accurate understanding of peripheral nerve anatomy of the PIP joint is essential to improve outcomes in denervation techniques.
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Affiliation(s)
- Martin Jose Pastrana
- Department of Anatomy, School of Medicine, University of Buenos Aires, Salta, Argentina
| | - Ezequiel Ernesto Zaidenberg
- Department of Anatomy, School of Medicine, University of Buenos Aires, Salta, Argentina; Department of Orthopaedics, Italian Hospital of Buenos Aires, Salta, Argentina; Kleinert-Kutz Institute for Hand and Microsurgery, Louisville, KY
| | - Dante Palumbo
- Kleinert-Kutz Institute for Hand and Microsurgery, Louisville, KY
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Development of Autologous Platelet-Rich Plasma Mixed-Microfat as an Advanced Therapy Medicinal Product for Intra-Articular Injection of Radio-Carpal Osteoarthritis: From Validation Data to Preliminary Clinical Results. Int J Mol Sci 2019; 20:ijms20051111. [PMID: 30841510 PMCID: PMC6429478 DOI: 10.3390/ijms20051111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
Wrist osteoarthritis (OA) is one of the most common conditions encountered by hand surgeons with limited efficacy of non-surgical treatments. The purpose of this study is to describe the Platelet-Rich Plasma (PRP) mixed-microfat biological characteristics of an experimental Advanced Therapy Medicinal Product (ATMP) needed for clinical trial authorization and describe the clinical results obtained from our first three patients 12 months after treatment (NCT03164122). Biological characterization of microfat, PRP and mixture were analysed in vitro according to validated methods. Patients with stage four OA according to the Kellgren Lawrence classification, with failure to conservative treatment and a persistent daily painful condition >40 mm according to the visual analog scale (VAS) were treated. Microfat-PRP ATMP is a product with high platelet purity, conserved viability of stromal vascular fraction cells, chondrogenic differentiation capacity in vitro and high secretion of IL-1Ra anti-inflammatory cytokine. For patients, the only side effect was pain at the adipose tissue harvesting sites. Potential efficacy was observed with a pain decrease of over 50% (per VAS score) and the achievement of minimal clinically important differences for DASH and PRWE functional scores at one year in all three patients. Microfat-PRP ATMP presented a good safety profile after an injection in wrist OA. Efficacy trials are necessary to assess whether this innovative strategy could delay the necessity to perform non-conservative surgery.
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