Using Joint Denervation to Treat Arthritis in the Hand, Wrist, Elbow

By John Flint MD

Physicians and surgeons are continually looking for ways to improve patients’ lives and solve medical problems with less invasive and less painful techniques. Just as important to patients, however, is minimizing the recovery time after medical procedures. In many ways, orthopedics has made great gains in reducing the invasiveness, pain and recovery time in orthopedic surgeries. For example, many of the orthopedic surgeries performed today are done arthroscopically, or through very small incisions with the aid of specialized tools and cameras. Additionally, hip replacement surgery is being done with smaller and small incisions and less and less trauma to the patient’s tissues during the surgery.
Hand surgeons have also made great progress in minimizing their surgical incisions and techniques to improve pain associated with surgery. One of the most common diagnoses treated by a hand surgeon is arthritis. Arthritis is most commonly the result of loss of cartilage at the joint surface, which leads to decreased range of motion, increased friction at the joint surface and most notably pain and discomfort. Orthopedists in general have made great strides in treating arthritis with therapy, injections and joint replacements. Joint replacements are very effective at reducing most of the symptoms of arthritis and solve the arthritis problem at their source – replacing the worn down cartilage surface with metal and plastic. However, joint replacements are major surgeries, are invasive and often require extensive rehabilitation and recovery time.
Given the hardship that patients face having a joint replacement, many hand surgeons have pursued other avenues of solving the problem of pain associated with arthritic joints without addressing the cartilage issues or requiring invasive joint replacement surgery. One of the pioneering procedures to reduce the pain associated with arthritic joints is called denervation. In a denervation procedure, the physician finds the nerves that send the painful signal from the joint back to the brain and disconnects the nerve. This doesn’t affect the sensation of the nearby fingers or skin, but only the nerves that transmit joint pain to the brain. Thus, with the joint nerves disconnected, the patient feels substantially less pain. The joint is still arthritic, and doesn’t move as well as a perfect joint, but the pain is greatly relieved. Moreover, the recovery after a denervation procedure is rapid, in terms of weeks, with very little in the way of restrictions, as compared to joint replacement surgery, which requires several months of recovery.
Joint denervation procedures have been performed extensively in the wrist for wrist arthritis with generally good results. More recently, as interest in denervation has increased among hand surgeons as a good option for many patients, they have performed denervation in other joints of the hand including the thumb joint and elbow joint. Most patients with wrist denervation experience substantial but not complete relief of their pain. With time, in the order of five to 10 years, most patients experience pain of the arthritic joints again. Thus, the denervation procedure gives good pain relief, rapid return to function, and doesn’t burn any bridges to future surgical treatment if they are needed. With the success in wrist denervation procedures, surgeons will continue to improve their techniques for joint denervation of other joints, such as fingers, thumbs and elbows in an effort to treat arthritis pain and speed up the recovery after surgery.

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