Neurectomy for joint pain

Overview

Neurectomy is a surgical procedure used to relieve chronic pain in the hand caused by arthritis. It involves selectively removing or interrupting small sensory nerves that transmit pain signals from the affected joint to the brain. This approach can be particularly beneficial for patients whose pain persists despite other treatments such as medication, splints, or joint injections.

Neurectomy is not suitable for every arthritic condition but can be effective in specific areas of the hand where pain is localised and joint movement is already limited. Common areas include:

• Thumb base (Carpometacarpal or CMC joint): Often affected by osteoarthritis, causing pain during gripping or pinching.
• Finger joints (Proximal or Distal Interphalangeal joints): Where arthritis leads to stiffness and persistent discomfort.
• Wrist joint: In cases of advanced arthritis where pain relief is the main goal rather than restoring motion.

The procedure is typically considered when other non-surgical treatments have not provided adequate relief and when joint replacement or fusion may not be appropriate.

Neurectomy is usually performed under general or regional anaesthetic for the wrist or CMC and local anaesthetic for the fingers as a day-case procedure.

1. A small incision is made near the affected joint.
2. The sensory nerve branches responsible for transmitting pain are identified.
3. These nerves are carefully divided or removed to interrupt pain signals.
4. The incision is closed with fine sutures, and a light dressing is applied.

The operation usually takes between 30 and 60 minutes, depending on the number of nerves treated.

• Immediate Post-Operative Care: The hand is kept elevated for the first few days to reduce swelling. Mild discomfort can be managed with simple pain relief.
• Dressings and Stitches: Stitches are typically removed after 10–14 days.
• Return to Activity: Light hand use can begin within a few days, with most patients returning to normal daily activities within 2–3 weeks.
• Physiotherapy: Gentle exercises may be recommended to maintain flexibility and prevent stiffness.

• Reduction or elimination of chronic joint pain.
• Improved hand comfort during daily activities.
• Avoidance or delay of more invasive procedures such as joint fusion or replacement.
• Quick recovery and minimal scarring.

As with any surgical procedure, neurectomy carries some risks:

• Proprioception loss: There can be loss of the feeling of how bent or straight the joint is when not looking at it which usually recovers. 
• Neuroma Formation: Occasionally, the cut end of a nerve may form a tender lump (neuroma), which can cause discomfort.
• Incomplete Pain Relief: Some patients may experience only partial or temporary relief.
• Infection or Scarring: Rare but possible complications at the incision site.
• Further surgery: In the wrist this can be 45% at 5 years.

Neurectomy is most suitable for patients with well-localised arthritic pain who have not responded to conservative treatments. A thorough assessment by a hand specialist at Mendip Hand Clinic will determine whether this procedure is appropriate based on the pattern of arthritis, pain distribution, and functional needs.