Upper Limb Partial Joint Denervation: Literature Study and New Concepts Propositions
Seance of wednesday 05 february 2020 (Communications libres)
DOI number : 10.26299/d0ct-mz31/emem.2018.3.011
Abstract
Introduction: First approach to the treatment of joint pain is medical. When all these methods are outdated, surgical interventions begin, proceeding from arthroscopy with a simple wash to total joint arthroplasty.
Partial joint denervation is the concept of preservation of joint function and pain relief by disconnecting the neural pathways from the pathologic joint to the brain.
Material and methods: Nerve pathways include final terminations for the ligaments, periosteum, capsule and cartilage of the diseased joint.
For each joint (20 wrist, 40 elbow, 20 shoulder), study required:
-anatomical dissection to identify innervation of the joint after silicone injection;
-description of a surgical approach (classical or endoscopic) to allow nerve branches disconnection.
Results: Nerve branches coming from peripheral nerves and intended to be capsular have either a direct origin from the nerve trunk, or from the motor branches of the muscles surrounding the wrist, elbow or shoulder joints.
Several approaches are necessary to identify and section the articular branches.
Discussion: Literature review reported only few schematic drawings at elbow and shoulder joints.
Hilton’s law (1863) has not yet been totally appreciated : «the same trunks of nerves whose branches supply the groups of muscles moving a joint furnish also a distribution of nerves to the skin over the insertions of the same muscles and the interior of the joint receives its nerves from the same source».
Results obtained for partial wrist denervation can probably be transposed successfully to the elbow and shoulder.
Conclusions: Partial joint denervation offers a complementary therapeutic proposal in the overall decision algorithm for surgical treatments. It does not compromise the performance of another surgical procedure on the bone and / or joint skeleton later.
Partial joint denervation is the concept of preservation of joint function and pain relief by disconnecting the neural pathways from the pathologic joint to the brain.
Material and methods: Nerve pathways include final terminations for the ligaments, periosteum, capsule and cartilage of the diseased joint.
For each joint (20 wrist, 40 elbow, 20 shoulder), study required:
-anatomical dissection to identify innervation of the joint after silicone injection;
-description of a surgical approach (classical or endoscopic) to allow nerve branches disconnection.
Results: Nerve branches coming from peripheral nerves and intended to be capsular have either a direct origin from the nerve trunk, or from the motor branches of the muscles surrounding the wrist, elbow or shoulder joints.
Several approaches are necessary to identify and section the articular branches.
Discussion: Literature review reported only few schematic drawings at elbow and shoulder joints.
Hilton’s law (1863) has not yet been totally appreciated : «the same trunks of nerves whose branches supply the groups of muscles moving a joint furnish also a distribution of nerves to the skin over the insertions of the same muscles and the interior of the joint receives its nerves from the same source».
Results obtained for partial wrist denervation can probably be transposed successfully to the elbow and shoulder.
Conclusions: Partial joint denervation offers a complementary therapeutic proposal in the overall decision algorithm for surgical treatments. It does not compromise the performance of another surgical procedure on the bone and / or joint skeleton later.