Funktionelle Ergebnisse nach Handgelenksdenervation

Abstract

The goal of this retrospective study was to examine the functional results after complete and partial denervation of the wrist, the time of postoperative pain reduction and the overall satisfaction of the patient related to the extend of denervation and preoperative diagnosis. 43 out of 70 patients with chronic wrist pain who underwent complete or partial wrist denervation from 1993 to 2000 were included in this study. The mean follow-up time was 51 (18-97) months. Prior to denervation a test denervation was performed with the injection of local anesthetics. In order to better differentiate between the overall treatment outcomes we categorized patients in three different groups based on their diagnosis. Group I consisted of 11 patients with radiocarpal arthrosis and carpal instability after SLAC- and SNAC-wrist. In group II 19 patients had radiocarpal arthrosis without carpal instability. Group III consisted of 13 patients without arthrotic changes in the wrist. Apart from the diagnosis we categorized the patients in a group A (29 patients) with complete denervation of the wrist and a group B (14 patients) with only partial denervation of the wrist. Pain reduction was assessed using the visual analog scale. Furthermore we evaluated wrist movement, grip strength, DASH-score, time of disability and the overall patient satisfaction with the procedure. The results were measured by using the Mayo-wrist- and Krimmer-wrist-score. Results of the preoperative test denervation were compared to the postoperative results. Statistical examination was performed between the different groups and comparing pre- to postoperative findings. 10 out of 26 patient, who's test denervation results were evaluated, reported good, 10 patients satisfactory and 6 modest pain reduction after test denervation. Only 13 (65%) of the 20 patients with good/satisfactory pain reduction after test denervation benefited from the operation. After the denervation pain was reduced in 30 patients (70%). Ten of these patients (33%) reported an increase of pain after 22 month on average. 20 patients (66%) were pain free at the time of reexamination. 22 patients (76%) in group A and 8 patients (57%) in group B reported postoperative pain reduction. 7 patients (64%) in group I, 12 patients (63%) in group II and 11 patients (85%) in group III reported postoperative pain reduction. Only in group III pain was statistically significantly decreased. Active range of motion for extension/flexion decreased in all groups postoperatively. Grip strength increased in all groups through the operation without statistical significance. The average DASH score of patients in group I was 37.8, in group II 45.5 and in group III 27.1. 6 patients (55%) in group I, 10 patients (53%) in group II and 10 patients (77%) in group III reported to be satisfied with the denervation. A positive test denervation is not a warranty for postoperative pain reduction after denervation of the wrist. Patients without arthrotic changes of the wrist benefit more from denervation than patients with arthrotic changes. Since the majority of patients with arthrotic changes still profited from a denervation we think of the operation as a valid alternative, since it leaves the possibility open for other, more difficult treatment options such as partial or total wrist fusion.