gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Denervation of the thumb carpometacarpal joint in the case of osteoarthritis: results of a controversial treatment option

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  • presenting/speaker Rebekka Rath - Orthopädische Klinik Markgröningen, Klinik für Handchirurgie und Plastische Chirurgie, Markgröningen, Germany
  • Christina Ampofo - Orthopädische Klinik Markgröningen, Klinik für Handchirurgie und Plastische Chirurgie, Markgröningen, Germany
  • Wan Konur - Zahnärztliche Oralchirurgische Praxis Dr. R. Gehl, Esslingen, Germany
  • Tobias Del Gaudio - Schwarzwald-Baar Klinikum, Klinik für Plastische-, Hand- und Ästhetische Chirurgie, Donaueschingen, Germany
  • Max Haerle - Orthopädische Klinik Markgröningen, Klinik für Handchirurgie und Plastische Chirurgie, Markgröningen, Germany

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-296

doi: 10.3205/19ifssh1138, urn:nbn:de:0183-19ifssh11384

Published: February 6, 2020

© 2020 Rath et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: If conservative treatment is not sufficient in thumb carpometacarpal (CMC1) joint osteoarthritis trapeziectomy is a valid procedure to reduce pain and gain back functionality. These operations destroy the carpal anatomy and some lead to reduced power and loading forces. This is a relevant problem especial for younger manual workers. Wrist denervation has shown to reduce pain relevantly in radiocarpal osteoarthritis. Therefore, we investigated on the effect of denervation in CMC1 osteoarthritis.

Methods: Between 2005 and 2018, 51 patients suffering from CMC1 (44) and STT(11) joint osteoarthritis underwent a denervation procedure which consisted in a total denervation (Wilhelm 1966) extended to the CMC1 joint (Lorea 2003). Pain (VAS), strength (grip and pinch), mobility (Kapandji index, range of motion), DASH score, complications and overall patient satisfaction were determined.

Results and Conclusions: The preliminary follow-up assessment showed a significant decrease in pain. 6 weeks post operation the pain reduction was 56.5 % and long-term pain reduction was 66.8 %. The postoperative strength of the pinch was 0.6 kg lower than on the other hand. Additionally, the postoperative mobility as measured by the Kapandji score was 9.3 of 10. Overall, 61% of patients are satisfied with the results of the denervation.

The results of our study implicate that a denervation can be an alternative treatment option for patients suffering from symptomatic osteoarthritis. A major advantage is pain reduction through a soft tissue procedure. Furthermore, other more invasive operative treatments are still an option after this operation. However, the long term pain reduction and the overall satisfaction rate is far inferior to the results of simple trapeziectomy. This is why we preserve this operation to patients with special physical requirements.