Houston Methodist. Leading Medicine

Wrist FAQ

Question:

The hand surgeon I've been seeing for my Kienböck disease has suggested an operation to cut the nerves to the wrist. I'm thinking about doing it but checking things out on the Internet first. I found your website and thought you might be able to offer some advice. What are the pros and cons of this kind of treatment?

Answer:

Kienböck disease is a condition in which one of the small bones of the wrist loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. While the exact cause of this uncommon disease isn't known, a number of treatment options are available. Early Kienböck disease is usually treated using nonsurgical treatments. Doctors may suggest immobilizing the wrist in a cast for up to three months. It is possible that the blood supply to the affected bone will return and the disease will clear up during this time. Splinting may be used to hold the wrist in a position of good alignment to help maximize blood flow that is present. Surgery may be suggested as in your case. The least invasive procedure would be denervation (cutting the sensory nerves to end pain signals). Numerous small studies have shown good results with this approach. There are very few disadvantages and many advantages. One of the positive features of a denervation procedure is the instant pain relief. Without the pain, many patients are finally able to move the wrist again. Grip strength improves as does the joint motion. Daily home and work activities become manageable. As with any surgery, there are always risks of complications such as infection, blood clot formation, or nerve palsy. With the type of surgery you are considering, there might be some bleeding into the area causing a hematoma (small pocket of pooled blood). This is a minor problem that will resolve on its own with time. The only real "down" side (if you can even call it that) is the fact that the underlying problem (in your case, the Kienböck disease) doesn't go away or even get better. Denervation can buy you some time though before considering more extensive surgery. Jefferson Braga-Silva, MD, PhD, et al. Wrist Denervation for Painful Conditions of the Wrist. In The Journal of Hand Surgery. June 2011. Vol. 36A. No. 6. Pp. 961-966.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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