Wrist Innervation Anatomy Provides a Roadmap for Chronic Pain Management

More than 11 million Americans self-report chronic wrist pain, which significantly reduces quality of life and causes economic hardship for many individuals. Although surgical interventions may offer relief after conservative pain management has failed, improvement in pain and function is inconsistent. Percutaneous denervation, a procedure that interrupts the signal from the nerve to the brain, is emerging as a non-invasive alternative for chronic wrist pain. A new study sought to map out potential anatomical sites of wrist pain, particularly the triangular fibrocartilage complex (TFCC), distal radio-ulnar joint (DRUJ), and radiocarpal joint (RCJ), with the aim of enhancing percutaneous denervation for pain management in this population.

Loretta T.S. Ho, John Tran, Anne M.R. Agur, and Philip W.H. Peng of the University of Toronto, Canada, received a Best of Meeting Abstracts Award from the American Society of Regional Anesthesia and Pain Medicine (ASRA) for its 20th Annual Pain Medicine Meeting, being held November 18-20, 2021. The authors will present Abstract #2505, “Applied Anatomy of Wrist Innervation Relevant to Ultrasound Guided Intervention for Chronic Wrist Pain” on Thursday, November 18.

By dissecting 14 cadavers, the team found the anterior interosseous, posterior interosseous, lateral antebrachial cutaneous, and dorsal cutaneous branches of the ulnar nerve in the arm innervate the TFCC, DRUJ, and RCJ sites in the wrist. Innervation was also found from the palmar cutaneous branch of the ulnar nerve (85%), palmar cutaneous branch of the median nerve (71%), medial antebrachial cutaneous nerve (65%), and superficial branch of the radial nerve (43%).

“Importantly, we were able to identify the corresponding bony and soft tissue landmarks that were identifiable on ultrasound imaging,” Ho et al. said. “Moving forward, the detailed mapping of the spatial relationship of the nerve supply to the wrist from this study provides the anatomical basis to optimise current and develop new percutaneous denervation protocols for chronic wrist pain.”

ASRA is a professional member organization of more than 5,000 physicians and healthcare providers across the United States and the world. The vision of ASRA is to relieve the global burden of pain. ASRA is dedicated to advancing the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Learn more at www.asra.com.