Introduction: Denervation is a simple alternative for the treatment of chronic pain syndromes of the wrist joint. It is a palliative resource with the limited objective of removing or relieving pain when other treatments attempted have failed to ensure an effective solution. The success of this procedure is based on a specific neurotomy of the articular branches of the nerves that go to the affected joint, without affecting the superficial and deep sensitivity. We present this work to evaluate the indications and outcomes over time of denervation of the wrist in arthritis stage 4. Methods: We performed a retrospective study of 26 patients with complete denervation of one of the wrists and of 36 patients with selective denervation, with a minimum follow-up of 24 months in both groups. Patients in whom denervation was accompanied by another procedure, such as partial fusion, internal fixation, or arthroplasty, were not included in this study. All patients underwent a preoperative test with local injection of lidocaine at 1%. As regards the surgical technique, we used 5 incisions for complete denervation, as was first advanced by Wilhelm and further modified by Foucher. The indications for this procedure were joint degenerative changes, stage 4, caused by navicular pseudarthrosis, Kienböck disease, scapholunate dissociation, and others. Results: The evaluation was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the test for assessing mobility and grip strength as measured by dynamometer comparison. Of 26 patients with complete denervation, 20 (76.92%) showed significant improvement in pain, 16 of whom were discharged without pain (61.53%). In 4 patients (15.38%), the result was moderate, with pain during heavy work. The remaining 2 patients did not show any improvement with the procedure. The 36 patients with selective denervation reported no pain or only mild pain during heavy work. All patients, considering both groups, retained at least the previous mobility and strength of grip, which was increased in many cases, whereas 2 patients had paresthesias in the back of the thumb that disappeared after 12 months. Conclusions: Denervation of the wrist is a simple and palliative treatment, which ensures good results in patients with painful restriction of mobility caused by degenerative changes. To achieve a good result, it is essential to have both an accurate knowledge of the anatomy of the articular branches of the peripheral nerves innervating the wrist and an adequate selection of patients by clinical, radiological, and lidocaine tests.
