Denervation of the Wrist Joint and Its Long Term Effect

Background The wrist joint is a common site of traumatic, degenerative and inflammatory disease that, when symptoms are severe, can be treated by partial or complete arthrodesis, arthroplasty and/or wrist denervation. Aim of the Work to review systematically studies about total and partial wrist denervation for chronic painful wrist conditions and meta-analyze the long term improvement. Materials and Methods Literature searches was conducted using the following databases: "PubMed, Ovid, Web of Science, Science Direct, Scopus, Cochrane Library, Google Scholar, Medline" using the following key words: wrist joint, total denervation, partial denervation for published studies. Results This study provides long-term data regarding the outcomes of partial and total wrist denervation. We have found that this is a reliable motion preserving procedure for patients with chronic wrist pain. In the series, 85% and 70% of patients did not undergo revision surgery at average follow-up of approximately 54.7 months and 47.5 months in total and partial denervation respectively. Conclusion Denervation is a relatively quick procedure with low complication rates and does not preclude salvage procedures if pain persists. It has been shown that neurectomy of the articular branches is possible without any injury to the important sensory and motor nerves of the hand. Total denervation of the wrist is a useful method for treating wrist pain when other choices compromise functional capacity or a long period of post-operative recovery is not desired.

Initial Electromyography Fails to Predict Long-Term Outcome of Isolated Serratus Palsy

Background and Aims: The course of isolated serratus palsy is difficult to predict, especially if, in initial electromyographic examination, long thoracic nerve function is totally absent. How initial electromyography correlates with long-term outcome of isolated serratus palsy is unknown. We evaluated initial electromyographic examinations of isolated serratus palsy patients and compared these to their long-term outcome. We hypothesized that long-term outcome after electromyographic examination–verified partial nerve injuries is better than that seen in cases of total nerve injuries. Patients and Methods: We retrospectively reviewed 90 patients with isolated serratus palsy and with initial electromyographic examination treated by brace or observation only, by determining pain, range of motion, and degree of scapular winging after a mean follow-up of 17.8 years. Results: Initial electromyographic examination showed total denervation in 21 cases (22%), partial severe denervation in 30 (33%), and partial moderate or slight denervation in 39 (44%). Recovery of serratus muscle function occurred in 17/21 cases (81%) of total denervation and in 47/69 cases (68%) of partial denervation, p = 0.247. Mean flexion in total denervation recovered to 152° and in partial to 157°, p = 0.301, and abduction to 173° and 174°, p = 0.970. In total denervation, 60% of patients were pain-free, in partial, 48%, p = 0.338. The duration of scapular winging among those 42 who subjectively recovered averaged 15.1 months, in 13 patients with total denervation 15.9 months, and in 29 patients with partial denervation 14.7 months (p = 0.599). Conclusion: Initial electromyographic examination does not predict clinical outcomes: ROM, pain, scapular winging and strength, but partial denervation may negatively predict subjective outcome.