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BSSH Autumn Meeting15th and 16th of October 2015London
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SCAPHOTRAPEZIOTRAPEZOID JOINT DENERVATION
PRELIMINARY RESULTS
BSSH Autumn Meeting15th-16th October 2015
LONDON
Mr Joan ARENAS-PRAT Mr Ganesh PRASAD
Pulvertaft Hand Centre. Royal Derby Hospital. DERBY
SCAPHOTRAPEZIOTRAPEZOID JOINTOSTEOARTHRITIS
SECOND MOST COMMON TYPE OF WRIST
OSTEOARTHRITIS
SURGICAL OPTIONS
. EXCISION ARTHROPLASTY +/- SOFT TISSUE INTEPOSITION. STT ARTHRODESIS. IMPLANT ARTHROPLASTY
ADVANTATGES OF JOINT DENERVATION
• SHORTER RECOVERY TIME• NO USE OF METALWORK OR IMPLANTS• NO INTERFERENCE WITH JOINT BIOMECHANICS• PRESERVES RANGE OF MOTION• NO LOSS OF PINCH OR GRIP STRENGTH• FURTHER SURGERY NOT PRECLUDED• IT DOES WORK
DISI DEFORMITY SECONDARY TO ABNORMAL BIOMECHANICS FOLLOWING TRAPEZIECTOMY WITH EXCISION OF PROXIMAL TRAPEZOID
HYPOTHETICAL COMPLICATIONS
LOSS OF PROPRIOCEPTION
. Gay A et al. J Hand Surg Am. 2011;36(11):1774-9. Effect of partial wrist denervation on wrist kinesthesia: wrist denervation does not impair proprioception.
. Dellon LA. J Hand Surg. 35(A): 1067-68. Pain affects proprioception more than denervation:“It is ok to lose your nerve when the nerve you lose impairs function”
INNERVATION OF THE STT JOINT
SURGICAL TECHNIQUE
.ARM TOURNIQUET
. REGIONAL BLOCK
. HAND TABLE
. WAGNER APPROACH
CLOSURE AND POST-OP
• THENAR MUSCLES REATTACHED WITH ABSORBABLE SUTURES TO BASE OF THUMB METACARPAL AND TRAPEZIUM
• SKIN CLOSURE + WOOL AND CREPE
• MOBILIZE IN 2 WEEKS
• REVIEW AT 2, 4 AND 6 MONTHS
UPDATED RESULTS (16 patients)
• N = 16. NO FORMAL STATISTICAL ANALYSIS• 28 MONTHS PERIOD. • 5 OF THEM HAD CONCURRENT 1ST CMC
JOINT DENERVATION • AGE RANGE 41 – 83• 11 PATIENTS PLEASED OR VERY PLEASED• 3 PATIENTS HAD NO IMPROVEMENT OF
ARTHRITIC PAIN (TWO OF THEM HAD CONCURRENT 1CMCJ OA)
• 2 PATIENTS UNHAPPY WITH RESULTS DUE TO HYPERSENSITIVE/PAINFUL SCAR
COMPLICATIONS
. 2 PATIENTS COMPLAINED OF PERSISTENT HYPERSENSITIVE SCAR .
. LATERAL ANTEBRACHIAL CUTANEOUS NERVE RUNS PARALLEL TO THE INCISION !!
CONCLUSION
l. EASY TECHNIQUE
l. LOW MORBIDITY
l. EASY AND QUICK REHABILITATION
l. DOES NOT PRECLUDE FURTHER SURGERY
l. IT DOES WORK
THANK YOU