First carpometacarpal joint denervation: anatomy and surgical technique.

The main goal of first carpometacarpal arthritis surgery is to relieve pain. The main disadvantage of the classic techniques (trapeziectomy, implant arthroplasty) is that they are extensive surgeries with potential complications, such as radial nerve paresthesia and synovitis. In the author's opinion, denervation of the first carpometacarpal joint is a viable option in selected cases. He describes the technique of denervation based on his previous anatomic investigations. Two incisions are needed to sever all the articular branches derived from the superficial branch of the radial nerve, the palmar cutaneous branch of the median nerve, the thenar branch of the median nerve, and the lateral antebrachial cutaneous nerve. Results comparable with trapeziectomy or first carpometacarpal joint fusion are obtained concerning pain. Complications are uncommon, except for temporary paresthesia of the radial nerve sensory branch.