Joint Denervation

Background

To treat arthritic pain without affecting the motion of the joint, a denervation can be completed. This involved clearing the nerves that go into a joint and report pain sensations back to the brain.

Although denervations of several joints are well described in surgical literature, they are still utilized sparingly. This is likely due to the fact that a denervation is either not performed well, or the patients are not selected well, leading to suboptimal results and patient (and provider) disappointment.

Denervations will only offer a certain degree of pain relief and are not equivalent to other procedures such as joint replacements and fusions.

Causes

Trauma, arthritis, posttraumatic arthritis, intraarticular fracture malunions, inflammatory conditions such as rheumatoid arthritis.

Symptoms

Pain is the primary reason to consider a joint denervation procedure.

Diagnosis

The history is critical in understanding to what degree the involved joint is causing symptoms. In terms of imaging, depending on the affected joint, an xray, MRI, and/or CT scan may be helpful in establishing a plan of action. A series of anesthetic injections can be considered in order to simulate a denervation procedure, depending on the joint involved.

Treatment

Dr. Dowlatshahi offers the following joint denervation procedures:

• Distal Interphalangeal Joint (DIP)
• Proximal Interphalangeal Joint (PIP)
• Metacarpophalangeal Joint (MCP)
• Thumb Carpometacarpal Joint (CMC)
• Wrist Joint including the radiocarpal and the distal radioulnar joint (DRUJ)

Here is the example of a 65 year old patient with DIP joint arthritis. He wanted a motion preserving procedure. He is 4 years postop with only occasional discomfort, and reports significant improvement from prior to surgery. The following images show the incision as well as the dissection of the small nerve fibers under the microscope. The dotted lines represent the anticipated course and location of the small nerve branches.

This patient had experienced a fracture of the MCP joint many years prior to her presentation to Dr. Dowlatshahi. Due to persistent pain, Dr. Sammy performed a keyhole arthroscopy procedure of the joint to clean it out and perform a synovectomy. The bone stepoff of the joint from the fracture was still visible. The joint was also surgically denervated leading to 90% reduction in the patients pain with return to baseline activities.