Purpose
Open and percutaneous denervation is an emerging technique for joint pain. This study
investigated the course and distribution of the articular branches innervating the
triangular fibrocartilage complex (TFCC), distal radioulnar joint (DRUJ), and radiocarpal
joint (RCJ) relative to bony and soft tissue landmarks to guide wrist denervation
procedures.
Methods
Fourteen formalin-embalmed specimens were serially dissected to expose the origin,
course, and distribution of articular branches innervating the TFCC, DRUJ, and RCJ.
Bony and soft tissue landmarks to localize each articular branch were documented and
visualized on a 3-dimensional reconstruction of the bones of the distal forearm and
hand.
Results
The TFCC was innervated by articular branches from the posterior interosseus nerve
(10 of 14 specimens), dorsal cutaneous branch of the ulnar nerve (14 of 14 specimens),
palmar cutaneous branch of the ulnar nerve (12 of 14 specimens), and medial antebrachial
cutaneous nerve (9 of 14 specimens). The DRUJ was innervated by the posterior interosseus
nerve (9 of 14 specimens) and anterior interosseus nerve (14 of 14 specimens). The
RCJ was innervated by the posterior interosseus nerve (14 of 14 specimens), superficial
branch of the radial nerve (5 of 14 specimens), lateral antebrachial cutaneous nerve
(14 of 14 specimens), and palmar cutaneous branch of the median nerve (10 of 14 specimens).
Conclusions
Multiple nerves were found to innervate the TFCC, DRUJ, and RCJ. The relationship
of anatomical landmarks to specific articular branches supplying the TFCC, DRUJ, and
RCJ can inform selective denervation procedures based on the structural origin of
pain.
Clinical relevance
The detailed documentation of the spatial relationship of the nerve supply to the
wrist provides clinicians with the anatomical basis to optimize current, and develop
new denervation protocols to manage chronic wrist pain.
Key words
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Article info
Publication history
Published online: July 20, 2022
Accepted:
May 5,
2022
Received:
December 11,
2021
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
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
