Minimally invasive denervation of the wrist: A cadaveric feasibility study for a single injection that targets both anterior and posterior interosseous nerves under ultrasound-guidance

Background

Wrist osteoarthritis poses significant challenges in pain management and functional impairment. Current surgical interventions often sacrifice wrist motion and entail long recovery times. Minimally invasive denervation offers a promising alternative by targeting sensory nerves. This study investigates the efficacy of ultrasound-guided chemical ablation with phenol-glycerin for wrist denervation.

Methods

Under ultrasound guidance, 1–3 mL of 1 % methylene blue:8 % phenol:8 % glycerin solution was injected on both side of the interosseous membrane of six unembalmed cadaveric wrists. The entry point of the 22-gauge needle was along the lateral border of the ulna, just proximal to the most proximal aspect of the ulnar head. Dissections of the anterior and posterior compartment of the forearm were performed to visualize the length of both posterior interosseous (PIN) and anterior interosseous (AIN) nerves that were stained.

Results

Results showed a successful dispersion of methylene blue staining along the PIN (2.1 ± 0.82 cm), deep to the fourth extensor compartment of the wrist posteriorly, and along the AIN (2.5 ± 1.10 cm), between the interosseous membrane and pronator quadratus muscle anteriorly. Importantly, this diffusion spared the main motor branches of both nerves. CONCLUSIONS. Minimally invasive denervation of the wrist using ultrasound-guided chemical ablation with phenol-glycerin shows promise in targeting the sensory branches of both interosseous nerves.