scaphotrapeziotrapezoid (stt) joint denervation

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