Outcomes and Predictors of Success of Thumb Carpometacarpal Joint Denervation

Abstract

Background:

Thumb carpometacarpal (CMC) joint osteoarthritis is a debilitating degenerative condition that primarily afflicts older adults. Traditional surgical interventions are effective but require prolonged recovery and potential loss of strength. Carpometacarpal joint denervation has emerged as an alternative due to its minimal recovery time and low morbidity. However, its conversion rate to arthroplasty and ideal patient selection criteria remain unclear.

Methods:

We retrospectively reviewed patients undergoing thumb CMC joint denervation from January 2019 to November 2023, excluding those with concurrent procedures or follow-up shorter than 6 months. We collected and analyzed demographic and clinical data, with primary functional outcomes assessed via Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Statistical analyses included Wilcoxon signed-rank tests for preoperative and postoperative comparisons and assessments of factors associated with achieving minimal clinically important difference (MCID).

Results:

Among 37 patients (mean age 56.4 ± 11.3 years, 70.3% female), 20 had complete preoperative and postoperative QuickDASH data. The median follow-up was 1.1 years. Although median QuickDASH scores improved from 39.8 to 14.8, the difference was not statistically significant (P = .073). Younger age (52.9 vs 63.8 years, P = .015) and dominant hand surgery (80% vs 20%, P = .023) were significantly associated with achieving MCID. Common complications included transient paresthesia (21.6%) and conversion to arthroplasty (13.5%).

Conclusions:

Thumb CMC joint denervation provides greater benefit for younger patients and those undergoing surgery on their dominant hand. The favorable complication profile and low conversion to arthroplasty support the role of denervation in the treatment algorithm for first CMC osteoarthritis.