Article
Managing Painful Wrist and Trapezio-Metacarpal Arthritis in Patients with SCI Using Surgical Joint Denervation
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Published: | February 6, 2020 |
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Objectives/Interrogation: Patients with spinal cord injury (SCI) have an increased incidence of painful wrist and trapezio-metacarpal arthritis due to the accumulated long-term load on their upper extremity or post-traumatically. However, many of the affected individuals opt against standard bony procedures, such as arthoplasty, joint implants or arthrodesis for fear of lengthy immobilisation, loss of motion, and other complications, e.g. postoperative instability.
Methods: We have studied the effects of alternative surgical denervation in 8 wrist and 7 trapezio-metacarpal joints (2 bilateral, 1 combined) during a 4-year period in 8 paraplegic and 4 tetraplegic individuals.
Results and Conclusions: Pain intensity regarding dropped by at least 50% on the visual analogue scale in all cases and results were rated as satisfactory by all patients.
No conversion to total joint arthrodesis was necessary within the follow-up time.
Surgical joint denervation seems to be an underused option to treat painful osteoarthritis in SCI patients as we are unaware of a previous description.
However, compared to more invasive methods, it provides important advantages as preserved joint integrity, no need for postoperative immobilization, technical simplicity, inexpensiveness and with low risk profile. All alternatives remain possible for future, e. g. arthrodesis or arthroplasty prosthesis and results can be reliably anticipated by preoperative test nerve blocks.
This study shows that surgical denervation of the wrist and thumb carpo-metacarpal joint is a minimally invasive option to reduce pain and preserve motion and function in this population with special demands.