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Wrist denervation in isolation: a prospective outcome study with patient selection by wrist blockade

PainSci » bibliography » Storey et al 2011
updated
Tags: hand & wrist, denervation, arm, limbs, neurology, treatment

Four articles on PainSci cite Storey 2011: 1. Complete Guide to Low Back Pain2. The Complete Guide to Patellofemoral Pain Syndrome3. The Complete Guide to Neck Pain & Cricks4. Do Nerve Blocks Work for Neck Pain and Low Back Pain?

PainSci commentary on Storey 2011: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

A small test (37 patients) of treating wrist pain by destroying nerve supply (in patients who had already responded well to a nerve block): “80% of patients had good or excellent results, as defined by an improvement of 5 or more points” on a pain scale to 10.

The test was not controlled by comparison of the treatment to a placebo, which is well-known to be essential for producing reliable results, particularly in surgery (see Louw), and so the authors’ conclusions must be taken with a grain of salt.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Surgical wrist denervation involves division of the anterior and posterior interosseous nerves and articular branches of the superficial radial nerve. In this outcome study, 37 patients were individually assessed and deemed suitable for denervation surgery due to appreciable symptom resolution following a local anesthetic wrist block. At a mean of 18 months following denervation surgery, median activity pain scores had decreased by 60% (p < 0.001) from initial assessment levels, and more than three quarters (30/37) of patients reported continued improvement in their activity pain (p < 0.001). More than two thirds of patients had a satisfaction VAS of greater than 50, with less postoperative resting pain and a greater reduction in postoperative activity pain as the important predictors of patient satisfaction. Thirty-one out of the 37 patients had not represented to our department for revision wrist surgery by a mean of 10.3 years follow-up. We have found this procedure useful in ameliorating symptoms for some patients who would conventionally have required partial or total wrist fusions with greater residual functional limitation.

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