Introduction to Denervation
Information for Patients
What is a denervation?
A denervation is a way to treat joint pain. Instead of injecting a joint to reduce inflammation or replacing a joint to improve function, a denervation reduces joint pain by interrupting the nerve signal to the joint. This is done by cutting the nerves to the joint and transferring them to the surrounding muscle. The nerves then grow into the surrounding muscle and change from ‘sensory' nerves to ‘motor’ nerves. This causes a cortical response in the brain, changing the brain matter, and removing the pain signal from the joint. It doesn’t change the fact that you have arthritis, but it makes it so you can’t feel it anymore.
What joints are best to denervate?
Denervation has worked best in the hand, wrist, base of thumb and knee. A recent study showed equivalent outcomes for base of thumb (CMC) denervation versus arthroplasty, but with a significantly shorter recovery time with denervation. Another study showed long-term pain relief in patients with knee pain due to osteoarthritis who were not candidates for a knee replacement.
Who benefits from a denervation?
Knee: In the knee patients who have failed conservative management with injections but are not candidates for a knee replacement may benefit from denervation. This can be particularly helpful for patients who are overweight, diabetic, or have other comorbidities. Patients who have had a knee replacement but still have pain can also benefit from this procedure.
Hand/Wrist/Thumb: Patients with arthritis of the hand/wrist/thumb can benefit from the quicker and cheaper recovery following a denervation procedure as compared to a traditional arthroplasty procedure.
Will I lose function?
Many patients wonder if cutting a nerve will lead to loss of function. Denervation procedures only remove the branches to the joint, not the entire nerve. This is similar to a freeway with on and off ramps. The procedure closes the on and off ramps to the joint, but does not shut down the freeway. The nerves continue to pass by the joint, and only the branches to the joint are cut.
Will my arthritis worsen?
A common misconception is that removing the pain signal to the joint will result in the joint wearing out much faster. The procedure is actually a partial denervation and only removes the pain sensing nerves. The proprioreceptive nerves remain intact, meaning spatial awareness and movement are still sensed. This results in only the pain being removed. We do not see rapid progression of arthritis after denervation procedures.
I had a knee replacement but still have pain.
If you are experiencing knee pain after a knee replacement you are not alone. Up to 20% of people who have a knee replacement still have pain. A denervation procedure is an excellent way to address residual knee pain following knee replacement surgery