PURPOSE:
Traumatic, arthritic, or iatrogenic joint pain is a major source of disability. Plastic Surgery has an innovative role to play in treatment of these painful conditions if A) joint innervation can be identified, and B) novel surgical approaches to these nerves can be devised. It is the purpose of this study to present a quarter century of experience with partial joint denervation for wrist, knee, ankle, shoulder and temporomandibular joint (TMJ).
METHODS:
Since 1979, anatomical investigation of specific joints has identified innervation patterns of wrist, knee, shoulder, lateral ankle (sinus tarsi), and TMJ joints. Selection of the patient with a painful joint for denervation requires local anesthetic blockade of the appropriate nerves (not intra-articular injection). Patient selection for denervation requires A) improvement of 5 points on visual analog pain scale and B) measurable improvement in joint range of motion. Outcomes are assessed at a minimum of 6 months after denervation.
RESULTS:
For the wrist (95 patients) and the knee (400 patients), 80% to 90% of the patients have good to excellent results. For the shoulder (15 patients) 75% have good to excellent results. For the lateral ankle (15 patients), 90% have excellent results. The first successful case of TMJ denervation will be presented.
CONCLUSION:
When traditional musculoskeletal approaches, including total joint replacement fail to relieve joint pain, then relief of pain and functional improvement can be achieved by partial joint denervation. Joint function (versus fusion) is preserved. Partial joint denervation opens a new area for Plastic Surgery.