Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Clinical Outcomes and Cadaveric Study

Sami Tuffaha, Amy Quan, Shar Hashemi, Pranay Parikh, Devin O'Brien-Coon, Justin M. Broyles, A. Lee Dellon, Scott Lifchez

Research output: Contribution to journalArticle

Abstract

Purpose: To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective joint denervation for the treatment of pain and impairment associated with thumb CMC arthritis. Methods: Cadaveric dissections were performed in 10 fresh upper extremities to better define the innervation patterns to the CMC joint and guide the surgical approach for CMC joint denervation. Histologic confirmation of candidate nerves was performed with hematoxylin and eosin staining. Results from a series of 12 patients with symptomatic thumb CMC arthritis who underwent selective denervation were retrospectively evaluated to determine the safety and efficacy of this treatment approach. Differences in preoperative and postoperative measurements of grip and key-pinch strength as well as subjective reporting of symptoms were compared. Results: Nerve branches to the thumb CMC joint were found to arise from the lateral antebrachial cutaneous nerve (10 of 10 specimens), the palmar cutaneous branch of the median nerve (7 of 10 specimens), and the radial sensory nerve (4 of 10 specimens). With an average follow-up time of 15 months, 11 of 12 patients (92%) reported complete or near-complete relief of pain. Average improvements in grip and lateral key-pinch strength were 4.1 ± 3.0 kg (18% ± 12% from baseline) and 1.7 ± 0.5 kg (37% ± 11% from baseline), respectively. One patient experienced the onset of new pain consistent with a neuroma that resolved with steroid injection. All patients were released to light activity at 1 week after surgery, and all activity restrictions were lifted by 6 weeks after surgery. Conclusions: Selective denervation of the CMC joint is an effective approach to treat pain and alleviate impairment associated with CMC arthritis. The procedure is well tolerated, with faster recovery as compared with trapeziectomy. Branches arising from the lateral antebrachial cutaneous nerve, palmar cutaneous branch of the median nerve, and radial sensory nerve can be identified and resected with a single-incision Wagner approach. Type of study/level of evidence: Therapeutic V.

Original languageEnglish (US)
JournalJournal of Hand Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Carpometacarpal Joints
Thumb
Denervation
Arthritis
Outcome Assessment (Health Care)
Pinch Strength
Radial Nerve
Pain
Skin
Median Nerve
Hand Strength
Safety
Neuroma
Hematoxylin
Eosine Yellowish-(YS)
Upper Extremity
Dissection
Joints
Steroids
Staining and Labeling

Keywords

  • Arthritis
  • denervation
  • nerve
  • thumb carpometacarpal joint
  • trapeziometacarpal joint

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis : Clinical Outcomes and Cadaveric Study. / Tuffaha, Sami; Quan, Amy; Hashemi, Shar; Parikh, Pranay; O'Brien-Coon, Devin; Broyles, Justin M.; Dellon, A. Lee; Lifchez, Scott.

In: Journal of Hand Surgery, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective joint denervation for the treatment of pain and impairment associated with thumb CMC arthritis. Methods: Cadaveric dissections were performed in 10 fresh upper extremities to better define the innervation patterns to the CMC joint and guide the surgical approach for CMC joint denervation. Histologic confirmation of candidate nerves was performed with hematoxylin and eosin staining. Results from a series of 12 patients with symptomatic thumb CMC arthritis who underwent selective denervation were retrospectively evaluated to determine the safety and efficacy of this treatment approach. Differences in preoperative and postoperative measurements of grip and key-pinch strength as well as subjective reporting of symptoms were compared. Results: Nerve branches to the thumb CMC joint were found to arise from the lateral antebrachial cutaneous nerve (10 of 10 specimens), the palmar cutaneous branch of the median nerve (7 of 10 specimens), and the radial sensory nerve (4 of 10 specimens). With an average follow-up time of 15 months, 11 of 12 patients (92{\%}) reported complete or near-complete relief of pain. Average improvements in grip and lateral key-pinch strength were 4.1 ± 3.0 kg (18{\%} ± 12{\%} from baseline) and 1.7 ± 0.5 kg (37{\%} ± 11{\%} from baseline), respectively. One patient experienced the onset of new pain consistent with a neuroma that resolved with steroid injection. All patients were released to light activity at 1 week after surgery, and all activity restrictions were lifted by 6 weeks after surgery. Conclusions: Selective denervation of the CMC joint is an effective approach to treat pain and alleviate impairment associated with CMC arthritis. The procedure is well tolerated, with faster recovery as compared with trapeziectomy. Branches arising from the lateral antebrachial cutaneous nerve, palmar cutaneous branch of the median nerve, and radial sensory nerve can be identified and resected with a single-incision Wagner approach. Type of study/level of evidence: Therapeutic V.",
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AU - Parikh, Pranay

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AU - Broyles, Justin M.

AU - Dellon, A. Lee

AU - Lifchez, Scott

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