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J Wrist Surg 2023; 12(03): 280-286
DOI: 10.1055/s-0042-1756498
Survey or Meta-Analysis

Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members

Nisha N. Kale 
1   Tulane University School of Medicine, New Orleans, Louisiana
,
Jake Foote
2   Department of Orthopaedics, MSUCHM Ascension Providence Hospital, Southfield, Michigan
,
Gleb Medvedev 
3   Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Abstract

Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain.

Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists.

Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation.

Results In total, 298 answered the survey. 46.3% (N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% (N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure (N = 185, 62.1%). Surgeons were more likely to offer the procedure (N = 133, 55.4%) if motion preservation had to be maximized (N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception (N = 224, 84.2%) or diminished protective reflex (N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation.

Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.

Keywords

SLAC - SNAC - wrist - denervation - arthritis

Note

The authors whose names are listed immediately below certify that they have no affiliations or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.




Publication History

Received: 11 October 2021

Accepted: 30 June 2022

Article published online:
07 October 2022

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