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Wrist denervation This is an operation that is generally done in young patients who have significant wrist pain. This may be from severe arthritis or from something like Keinbock's disease. It is used in a situation where a patient needs to maintain range of movement of the wrist perhaps to continue their job as a manual worker but cannot cope with the pain. What is done is that the nerves that supply feeling or pain to wrist joint are cut. There are branches of all three nerves that supply the hand (radial, median and ulnar nerves) that go to the wrist and these have to be identified and cut. The useful thing about this operation is that one can test how well it will work by anaesthetising these nerves in the outpatient clinic and the patient can go away and within 6 hours the effects of the operation will be simulated. If the patient is happy then the operation will be performed. ANAESTHETIC General or regional anaesthetic. OPERATIVE PROCEDURE Incisions There are multiple incisions around the wrist. Three on the front of the wrist and three on the back. Procedure Through these incisions, under magnification, the sensory nerves (nerves that supply sensation) to the wrist from each nerve are identified and dissected. This is an intricate procedure that takes about one and a half hours. Wounds are closed using a nylon suture. POST OPERATIVELY The hand is wrapped up in a bandage, elevated over night to try and reduce swelling. Generally the patient is sent home the next day. The bandage is kept on for two weeks and reviewed in outpatients. The advantage of this is that there is no plaster cast. COMPLICATIONS
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