SCAPHOTRAPEZIOTRAPEZOID

JOINT DENERVATION
PRELIMINARY RESULTS
BSSH Autumn Meeting
15th-16th October 2015
LONDON
Mr Joan ARENAS-PRAT
Mr Ganesh PRASAD
Pulvertaft Hand Centre. Royal Derby Hospital. DERBY

SCAPHOTRAPEZIOTRAPEZOID JOINT
OSTEOARTHRITIS
SECOND MOST COMMON TYPE OF WRIST
OSTEOARTHRITIS
SURGICAL OPTIONS
. EXCISION ARTHROPLASTY +/- SOFT TISSUE
INTEPOSITION
. STT ARTHRODESIS
. IMPLANT ARTHROPLASTY

ADVANTATGES OF JOINT DENERVATION

SHORTER RECOVERY TIME

NO USE OF METALWORK OR IMPLANTS
NO INTERFERENCE WITH JOINT BIOMECHANICS
PRESERVES RANGE OF MOTION
NO LOSS OF PINCH OR GRIP STRENGTH
FURTHER SURGERY NOT PRECLUDED
IT DOES WORK

DISI DEFORMITY SECONDARY TO ABNORMAL BIOMECHANICS FOLLOWING

TRAPEZIECTOMY WITH EXCISION OF PROXIMAL TRAPEZOID

HYPOTHETICAL COMPLICATIONS
LOSS OF PROPRIOCEPTION

. Gay A et al. J Hand Surg Am. 2011;36(11):1774-9. Effect of partial

wrist denervation on wrist kinesthesia: wrist denervation does not
impair proprioception.
. Dellon LA. J Hand Surg. 35(A): 1067-68. Pain affects
proprioception more than denervation:It is ok to lose your nerve
when the nerve you lose impairs function

INNERVATION OF THE STT JOINT

SURGICAL TECHNIQUE

.ARM TOURNIQUET
. REGIONAL BLOCK
. HAND TABLE
. WAGNER APPROACH

CLOSURE AND POST-OP

THENAR MUSCLES REATTACHED WITH ABSORBABLE

SUTURES TO BASE OF THUMB METACARPAL AND
TRAPEZIUM

SKIN CLOSURE + WOOL AND CREPE

MOBILIZE IN 2 WEEKS

REVIEW AT 2, 4 AND 6 MONTHS

UPDATED RESULTS (16 patients)

N = 16. NO FORMAL STATISTICAL ANALYSIS

28 MONTHS PERIOD.
5 OF THEM HAD CONCURRENT 1ST CMC
JOINT DENERVATION
AGE RANGE 41 83
11 PATIENTS PLEASED OR VERY PLEASED
3 PATIENTS HAD NO IMPROVEMENT OF
ARTHRITIC PAIN (TWO OF THEM HAD
CONCURRENT 1CMCJ OA)
2 PATIENTS UNHAPPY WITH RESULTS DUE
TO HYPERSENSITIVE/PAINFUL SCAR

COMPLICATIONS

. 2 PATIENTS COMPLAINED OF PERSISTENT HYPERSENSITIVE SCAR .

. LATERAL ANTEBRACHIAL CUTANEOUS NERVE RUNS PARALLEL
TO THE INCISION !!

CONCLUSION

. EASY TECHNIQUE

. LOW MORBIDITY

. EASY AND QUICK REHABILITATION

. DOES NOT PRECLUDE FURTHER SURGERY

. IT DOES WORK

THANK YOU