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.
Key words
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Article info
Publication history
Published online: June 19, 2018
Accepted:
April 25,
2018
Received:
June 3,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
