|
A.E. Freeland, MD and D.T. Batarseh, MD, Jackson , MS
Introduction
The purpose of this study was to determine if preoperative differential wrist blocks were accurate discriminators for targeted wrist denervation for the treatment of severe chronic wrist pain and to determine if wrist denervation then provided reliable pain relief.
Clinical Material and Methods
Twenty-eight consecutive patients with chronic wrist pain that was constant, beyond their tolerance (7 or greater on the pain analog scale), refractory to non-operative treatment, and who wished to avoid the prolonged morbidity of reconstructive surgery were evaluated. Patients had differential blocks to identify the nerve(s) involved in their pain transmission. Resolution or relief of the pain to within the patient's tolerance (less than 3 on the pain analogue scale) qualified the patient for wrist denervation of the involved nerves. The average age at the time of surgery was 51 years. Causes of chronic pain included residual arthritis from distal radial fractures or Keinboch's disease and residual pain or arthritis from carpal, ulnocarpal, or distal radioulnar injury or instability.
Results
The average follow-up after surgery was one year. Using a 0-10 subjective pain analog scale, there was an average reduction of maximum resting pain from 8.2 to 1.8 (78% improvement). Eighty-eight percent of patients (25 of 28) were satisfied with their procedure and would retrospectively have it performed again.
Two patients required later proximal row carpectomy and one, a wrist fusion , after which they had satisfactory pain relief and function. Complications included one instance of ulnar neuritis. No Charcot joint changes were seen.
Conclusion
Preoperative differential blocks were an accurate selection discriminator for partial wrist denervation and wrist denervation was an effective and reliable procedure for pain control in 88% of the patients treated in this series. |
