Long-term follow-up evaluation of denervation of the wrist. 2006

Andreas Schweizer, and Oliver von Känel, and Erich Kammer, and Claudia Meuli-Simmen
Division of Plastic, Reconstructive and Hand Surgery, Kantonsspital Aarau AG, Tellstrasse, Aarau, Switzerland. andreas.schweizer@ksa.ch

OBJECTIVE To evaluate the indications and results of complete wrist denervation and to focus on the correlation between results and length of follow-up evaluation. METHODS A retrospective review was performed of 71 complete denervations of the wrist joint in 70 patients with an average follow-up period of 9.6 years (range, 1-23 y) using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The denervations were performed according to the description by Wilhelm. All patients were asked to provide a DASH score. The indications for surgery were degenerative changes caused by scaphoid nonunions (25), distal radius fracture (11), Kienböck's disease (11), primary degenerative arthritis (9), scapholunate dissociation (8), and others (7). RESULTS The average DASH score was 26 (range, 0-88). Thirty-nine patients (40 wrists) reported considerable improvement, 8 reported little improvement, and 10 reported temporary improvement after surgery. Seven experienced no change and 6 experienced worsening after surgery. Twenty-two patients were completely free of pain and 13 (14 wrists) had little, 20 had moderate, 11 had considerable, and 4 had severe pain. Forty-eight patients (49 wrists) stated that they would repeat the denervation and 61 (62 wrists) were able to keep their former occupations. There was a trend toward lower (improved) DASH scores in patients with longer follow-up periods but this did not reach statistical significance. The best results were achieved in patients with scapholunate dissociations and the worst results occurred in old distal radius fractures. Patient age did not influence the results. Nine patients with unsatisfactory results needed a second procedure. CONCLUSIONS Complete wrist denervation resulted in subjective long-term improvement in two thirds and in a complete or marked pain relief in half of the patients. Patients with longer postoperative time and younger age did not affect the results adversely. This procedure is simple and fast, does not decrease range of motion, and leaves all other surgical options open. METHODS Therapeutic, Level IV.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010147 Pain Measurement Scales, questionnaires, tests, and other methods used to assess pain severity and duration in patients or experimental animals to aid in diagnosis, therapy, and physiological studies. Analgesia Tests,Analogue Pain Scale,Formalin Test,McGill Pain Questionnaire,Nociception Tests,Pain Assessment,Pain Intensity,Pain Severity,Tourniquet Pain Test,Visual Analogue Pain Scale,Analog Pain Scale,Assessment, Pain,McGill Pain Scale,Visual Analog Pain Scale,Analgesia Test,Analog Pain Scales,Analogue Pain Scales,Formalin Tests,Intensity, Pain,Measurement, Pain,Nociception Test,Pain Assessments,Pain Intensities,Pain Measurements,Pain Questionnaire, McGill,Pain Scale, Analog,Pain Scale, Analogue,Pain Scale, McGill,Pain Severities,Pain Test, Tourniquet,Questionnaire, McGill Pain,Scale, Analog Pain,Scale, Analogue Pain,Scale, McGill Pain,Severity, Pain,Test, Analgesia,Test, Formalin,Test, Nociception,Test, Tourniquet Pain,Tests, Nociception,Tourniquet Pain Tests
D003714 Denervation The resection or removal of the nerve to an organ or part. Laser Neurectomy,Neurectomy,Peripheral Neurectomy,Radiofrequency Neurotomy,Denervations,Laser Neurectomies,Neurectomies,Neurectomies, Laser,Neurectomies, Peripheral,Neurectomy, Laser,Neurectomy, Peripheral,Neurotomies, Radiofrequency,Neurotomy, Radiofrequency,Peripheral Neurectomies,Radiofrequency Neurotomies
D004185 Disability Evaluation Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workmen's compensation benefits. Disability Evaluations,Evaluation, Disability,Evaluations, Disability
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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