Small Joint Denervation: Cutting the Cord Without Burning the Bridge

Small joint osteoarthritis of the hands and fingers accounts for a significant portion of the osteoarthritis burden and is a major cause of pain and functional limitations. Arthroscopy with debridement, arthrodesis, arthroplasty, and tendon interposition and suspension remain standard surgical options but are associated with motion loss, prolonged recovery, and risk of revision. Small joint denervation, however, has emerged as a motion-preserving alternative that does not alter joint mechanics but can significantly improve pain. This narrative summarizes the anatomic foundation, surgical techniques, and clinical outcomes of denervation for small-joint osteoarthritis, compared with more traditional procedures and emerging minimally invasive alternatives, including autologous fat grafting, bone marrow aspirates, and platelet-rich plasma. This manuscript highlights the benefits of denervation, including noticeable pain reduction, preserved range of motion, and rapid postprocedural recovery. Overall, denervation of the carpometacarpal, metacarpophalangeal, and proximal interphalangeal joints can be considered as a promising, minimally invasive strategy for managing osteoarthritis-related pain while maintaining future surgical options if necessary. Further standardized techniques, randomized clinical trials, and long-term follow-up are needed to better determine its place in the treatment algorithm for hand osteoarthritis.