What is wrist denervation?

Surgical denervation of the wrist is a useful palliative procedure for chronic wrist pain when reconstructive procedures are not feasible or desirable.

Wrist denervation aims to stop nerves that are transmitting pain such as the anterior and posterior interosseous nerves (near the wrist joint) and the articular branches of the superficial radial nerve. The procedure can allow for long-lasting pain relief and better function of the wrist, and is performed by a specialist orthopaedic surgeon.
 

Which conditions might require wrist denervation?

Degenerative arthritis is a condition that leads to the painful limitations of wrist motion and indicates that wrist denervation is necessary.

Other indicators include scaphoid nonunion, painful carpal instability, ligament injury and Kienbock’s disease.
 

What is the surgical procedure used during wrist denervation?

Wilhelm’s wrist denervation is a surgical procedure used to cut tiny branches of the sensory nerves to the wrist and hand. Cutting these nerve pathways means that pain signals to the brain can be stopped. The motor nerves are not disturbed so there is no loss of motion or strength.

The operation takes around 45 minutes and involves four small incisions on both the front and back of the wrist and hand. The incisions are closed with wire sutures and a dorsal plaster splint is applied. 

Following surgery, grip, strength, wrist motion and pain improves.

Are there any risks associated with the wrist denervation procedure?

As with all types of surgery, there are some risks associated with this procedure. The main potential wrists include:

• Infection and bleeding: all surgical procedures carry a risk of infection and the possibility of bleeding, although the occurence is relatively rare.
• Nerve damage: as the procedure requires working closely on the nerves, there is always a risk of damage to the nerve structures, which can result in loss of sensation, weakness, or a change in sensation in the hand and wrist.
• Not complete pain relief: the goal of the surgery is to alleviate pain in the wrist and hand, but the surgery may not be completely succesful, with some pain remaining. 

If you would like to make an appointment with a specialist in wrist denervation, you can find them here.