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Osteoarthritis
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Surgical denervation as a treatment strategy for pain in hand osteoarthritis: a systematic literature review
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  • Published on: 14 August 2023
    Denervation to treat painful OA of the hand
    • Joan Arenas-Prat, Hand Surgeon Pulvertaft Hand Centre. Royal Derby Hospital. Uttoxeter New Road. DERBY DE22 3NE United Kingdom

    I have read with much interest the present article and there are some relevant points that I think should be clarified because they completely disagree with the most recent research regarding hand joint denervation or hand neuroanatomy in general.
    Van Der Meulen C. et al don’t recommend joint denervation to treat painful OA of the hand because of a lack of proper trials and studies to support this treatment. However, in that respect, Hustedt JW et al have recently conducted a prospective study confirming that results of both trapeziectomy (suspension arthroplasty) and denervation are identical (1). This, in my opinion, invalidates the authors’ reccomendations -at least- as far as 1st CMCJ denervation is concerned.
    Furthermore, another of the authors’ reccomendations would be a trial to compare surgical denervation to other interventions targeting articular sensory nerves such as radiofrequency ablation. This technique is already used for spinal facet or knee joint painful arthropathies however it is virtually impossible to be performed at hand level because of anatomical reasons. Identification of articular sensory nerves of the hand can only be achieved through accurate surgical exposure because they are very small branchlets arising from bigger sensory and motor branches. They are only visible under loupe magnification and any local radiofrequency ablation in that area would inevitably cause damage to the main nerves that give off these articular sensory fib...

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    Conflict of Interest:
    None declared.