The management of chronic wrist pain is a challenging clinical problem. Wrist denervation aims to achieve an improvement in pain through selective neurotomy, irrespective of cause. Numerous authors have reported their experience and demonstrated a range of clinical outcomes. No studies to date have reliably identified patient populations in whom denervation surgery is most likely to succeed. We aimed to establish and investigate a new approach, combining local anaesthetic injections with a uniquely tailored functional assessment by a hand therapist, to act as a tool to identify individuals in whom surgical denervation is more likely to yield benefit. We conducted a retrospective review of 17 patients who had undergone wrist denervation procedures following our method of pre-operative assessment and selection. Patients in whom denervation was combined with other diagnostic or therapeutic surgical procedures were excluded. Each patient underwent an initial assessment by a hand therapist in which pain and functional scores were recorded using the Patient Rated Wrist Evaluation (PRWE). Further unique assessments of function were made, tailored to the functional goals and requirements of each patient. Pain scores were measured for each task. Local anaesthetic injections were then administered around the nerves considered for neurotomy and the assessments were repeated. Patients who demonstrated clear improvements in pain and function underwent surgery. Post-operative assessments of pain and function were repeated.Introduction
Methods
Increasing emphasis is placed on outcomes research. In this community study knee outcomes scores were evaluated in a ‘normal’ elderly population The American knee society (AKS), Oxford, and Bristol knee scores were recorded in 100 elderly people without a history of lower limb disorder. The mean age of subjects was 72 years. Mean normalised scores were 90%, 91% and 94% for AKS, Oxford and Bristol knee scores respectively. There were significant negative correlations between knee score and advanced age (p<
0.001) and knee score and co-existent major medical disorders (p<
0.001). The function component was the score component most senitive to these variables (p<
0.001) Control studies are necessary if knee scores are to be taken as accurate measures of outcome. Comparison of outcome after knee replacement on the basis of knee scores should take account of demographic variables. Scores with a large ‘function’ component appear to be more susceptible to demographic variation.
