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    Denervation of The Trapeziometacarpal Joint

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    Hand Surgery
    Advanced Derby Hand Course Pulvertaft Hand Centre 23rd and 24th of May, 2013 Breadsall Priory DERBY UK

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    Denervation of The Trapeziometacarpal Joint

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    Hand Surgery
    682 views17 pages
    Advanced Derby Hand Course Pulvertaft Hand Centre 23rd and 24th of May, 2013 Breadsall Priory DERBY UK

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    Denervation of the trapeziometacarpal joint

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    Advanced Derby Hand Course Pulvertaft Hand Centre 23rd and 24th of May, 2013 Breadsall Priory DERBY UK

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    682 views17 pages

    Denervation of The Trapeziometacarpal Joint

    Uploaded by

    Hand Surgery
    Advanced Derby Hand Course Pulvertaft Hand Centre 23rd and 24th of May, 2013 Breadsall Priory DERBY UK

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    Advanced Derby Hand Course 23rd and 24th May 2013 DERBY

    DENERVATION OF THE TRAPEZIOMETACARPAL JOINT


    Joan M. Arenas-Prat Pulvertaft Hand Centre, Derby Serveis Medics Penedes, Barcelona

    WHAT IS JOINT

    DENERVATION?
    Surgical technique to isolate a joint from its sensitive branches in order to treat osteoarthritic pain

    arenasprat@hotmail.com

    HISTORICAL PERSPECTIVE

    TMCJ denervation was first described by Lora in 2002 following the same principles of Wilhelm's wrist denervation in 1966

    Lora P, Dury M, Marin Braun F, Dekka T, De Mey A, Foucher G. Trapeziometacarpal denervation.Description of surgical technique and preliminary results from a prospective series of fourteen cases.Chir Main. 2002;21:209-17. Wilhelm A. Die Gelenkdenervation und hire anatomischen Grundlagen. Hefte zur Unfallheilk. 1966;86:1-109.
    arenasprat@hotmail.com

    WHY DENERVATION ?
    Simple technique Does not interfere with biomechanics of joint Faster recovery time Does not preclude further surgery Because it works

    arenasprat@hotmail.com

    DENERVATION FACTS
    All or nothing technique. Avoid partial or shy denervations

    Pain relief

    Pain relief

    amount of divided articular rami


    arenasprat@hotmail.com

    amount of divided articular rami

    DENERVATION FACTS (2)


    Most orthopaedic operations imply a degree of involuntary denervation Pre-operative tests with local anaesthetic might exclude patients that otherwise would benefit from denervation

    arenasprat@hotmail.com

    DENERVATION MYTHS
    DENERVATION AND PROPRIOCEPTION : A LONGSTANDING CONTROVERSY
    J Hand Surg Am. 2011 Nov;36(11):1774-9. Effect of partial wrist denervation on wrist kinesthesia: wrist denervation does not impair proprioception. Gay A et al J Hand Surg Am. 2010 Jul;35(7):1059-66. Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes. Hagert E, Persson JK. J Hand Surg Am. 2010 Jul;35(7):1067-9. : Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes: it is ok to lose your nerve . Dellon AL
    arenasprat@hotmail.com

    DENERVATION MYTHS(2)
    END OF CONTROVERSY ?

    There is no clinical evidence that denervation affects proprioception (longstanding controversy)

    Pain affects proprioception more than denervation: It is ok to lose your nerve when the nerve you lose impairs function AL. Dellon Apart from capsular and ligamentous receptors proprioception is regulated by skin and musculotendinous receptors

    arenasprat@hotmail.com

    CONTRAINDICATIONS

    Grossly unstable joints Joint deformities that impair function

    arenasprat@hotmail.com

    TECHNIQUE

    Traditional techniques involve a single dorsal incision or two smaller dorsal and volar incisions

    Wagner approach, apart from the three main sensitive articular branches, also addresses the sensitive rami from the thenar branch of the median nerve +/- deep branch of ulnar nerve
    Lora PD. First carpometacarpal joint denervation: anatomy and surgical technique. Tech Hand Up Extrem Surg. 2003;7:26-31. Lora P, Dury M, Marin Braun F, Dekka T, De Mey A, Foucher G. Trapeziometacarpal denervation. Description of surgical technique and preliminary results from a prospective series of fourteen cases. Chir Main. 2002;21:209-172 Arenas-Prat, JM. Wagner approach for first carpometacarpal denervation. Tech Hand Up Extrem Surg. 2012 Jun;16(2):107-9. Miki RA et al. Ulnar nerve component to innervation of thumb carpometacarpal joint. Iowa Orthop J. 2011; 31: 225230.
    arenasprat@hotmail.com

    arenasprat@hotmail.com

    arenasprat@hotmail.com

    arenasprat@hotmail.com

    arenasprat@hotmail.com

    POST OPERATIVE CARE

    Early mobilization as pain allows Assess results 3 months after surgery, when most post-operative pain will have subsided

    Inform patient that residual pain can be beneficial because protects the joint from excessive strain

    arenasprat@hotmail.com

    It's only denervation. But I like it.


    The Rolling Stones . 1974

    arenasprat@hotmail.com

    Thank you

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