Partial Joint Denervation I: Wrist, Shoulder, and Elbow

Background: Partial joint denervation is the concept of preservation of joint function and relief of joint pain by interrupting the neural pathways that transmit the pain message from the joint to the brain. When traditional, non-operative, musculoskeletal approaches fail, the surgical approach may require joint fusion or replacement arthroplasty. The purpose of this article is to extend these concepts from the wrist to the elbow and shoulder. Methods: For each joint, research required (1) anatomical dissection to identify innervation of the specific joint, (2) identification of route through which to administer local anesthetic based on new anatomical knowledge, (3) demonstration that pain relief is possible by injection of local anesthetic in patients who have failed traditional musculoskeletal treatments for that joint, (4) creation of surgical approach(es) to resect involved nerve(s), and (5) documentation of success of this approach with an appropriate patient population. Results: The results obtained for partial joint denervation of the wrist can be applied successfully to the elbow and shoulder. If anesthetic block of joint innervation results in greater than or equal to a five-point reduction in visual analogue scale score, 90 percent of the patients can expect good to excellent pain relief from partial joint denervation. Conclusions: Partial joint denervation offers an outpatient, ambulatory operative approach that is joint sparing and rehabilitation free. For plastic surgery, this concept opens new areas for patient care, permitting relief of pain and restoration of function to joints even proximal to the wrist, permitting plastic surgeons to bring this hope to our orthopedic and pain management colleagues. (Plast. Reconstr. Surg. 123: 197, 2009.)