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Partial wrist denervation versus patient education and self-managed exercise therapy in patients with wrist
Sara L Larsson1,2, Tobias Tandrup3,4, Elisabeth Brogren1,2
1Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
Background:
Wrist osteoarthritis (OA) is mainly posttraumatic, affects younger individuals than other types of OA, and can lead to significant disability. The first-line treatment is patient education and exercise, but surgery may be considered if symptoms persist. A mini-invasive surgical approach for wrist OA is partial wrist denervation, which, in theory, alleviates pain by resecting sensory nerve branches while preserving movement. Although denervation has shown mixed results, studies suggest improvements in pain and function. However, the long-term efficacy remains uncertain, with a notable percentage of patients requiring further surgical interventions. This randomized controlled trial (RCT) aims to compare the effectiveness of partial wrist denervation to nonsurgical treatment, consisting of patient education and a self-managed exercise therapy program.
Methods:
In this multicenter, two-armed, assessor-blinded, superiority RCT, 140 adult patients with symptomatic scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) OA are randomly assigned (1:1) to receive either partial denervation through neurectomy of the anterior (AIN) or posterior (PIN) interosseous nerves or patient education combined with a self-managed exercise therapy program focused on wrist stability and muscle strength. The primary outcome is the change in the Patient-Rated Wrist Evaluation (PRWE) score at 6 months. Secondary outcomes include wrist range of motion, grip strength, pain levels, survival of the interventions, and quality of life over 12 months.
Discussion:
High-quality evidence regarding the effectiveness of different treatment options in wrist OA is lacking. To our knowledge, this is the first RCT comparing surgical and nonsurgical treatments in wrist OA. Using patient education and exercise therapy as a comparator to partial wrist denervation ensures ethical, clinically relevant care aligning with current OA treatment standards. Ultimately, the findings of this trial will guide and optimize treatment recommendations for wrist OA.
Trial Registration:
ClinicalTrials.gov ID NCT06098586. Registered on 23 Oct 24.
