Monday, October 11, 2004 - 2:40 PM
6575

PSEF 2004 Scientific Essay Contest - Senior Award, Clinical Research: Partial Joint Denervation: First Applications to the Ankle, Shoulder, Elbow and Hip

A. Lee Dellon, MD

Partial joint denervation is the concept that joint pain can originate from pathology to the nerves that innervate a joint. These nerves can be stretched or torn from trauma to the joint or injured by surgical maniupulation during attempts at joint or ligament reconstruction. To accomplish partial joint denervation it is necessary to identify the nerves that innervate the joint, prove that the patient obtains relief of pain by a local nerve block of one or more of those nerves, and then devise a surgical approach for the actual denervation procedure itself. The wrist joint had this approach pioneered by Dellon with the description of the posterior interosseous nerve to the dorsal wrist in 1979, and the description of partial volar and partial dorsal wrist denervation procedures in 1984 an 1985. In 1993, the innervation of the human knee joint was described by Horner and Dellon, and then in 1994, 1995 clinical series of partial knee denervation procedures were described for patients after total knee arthroplasties, ligamentous injuries to the knee, and direct trauma. This approach was then applied to the shoulder, elbow, ankle and temporomandibular joint. The presentation will include the anatomic description of the nerves to these joints, the clinical approach suggested for the nerve blocks to the nerves that innervate these joints, and clinical examples of partial denervation of the shoulder, elbow, and ankle.