# Partial wrist denervation versus patient education and self-managed exercise therapy in patients with wrist osteoarthritis: study protocol for a randomized controlled trial

## TL;DR

This study compares a surgical procedure called partial wrist denervation with nonsurgical treatments for wrist osteoarthritis to determine which is more effective in reducing pain and improving function.

## Contribution

This is the first randomized controlled trial comparing surgical and nonsurgical treatments for wrist osteoarthritis.

## Key findings

- The trial will assess the effectiveness of partial wrist denervation versus patient education and exercise therapy.
- Results will provide high-quality evidence to guide treatment recommendations for wrist osteoarthritis.
- The study will evaluate outcomes such as pain, function, and quality of life over 12 months.

## Abstract

Wrist osteoarthritis (OA) is mainly posttraumatic, affects younger individuals than other types of OA, and can lead to significant disability. The first-line treatment is patient education and exercise, but surgery may be considered if symptoms persist. A mini-invasive surgical approach for wrist OA is partial wrist denervation, which, in theory, alleviates pain by resecting sensory nerve branches while preserving movement. Although denervation has shown mixed results, studies suggest improvements in pain and function. However, the long-term efficacy remains uncertain, with a notable percentage of patients requiring further surgical interventions. This randomized controlled trial (RCT) aims to compare the effectiveness of partial wrist denervation to nonsurgical treatment, consisting of patient education and a self-managed exercise therapy program.

In this multicenter, two-armed, assessor-blinded, superiority RCT, 140 adult patients with symptomatic scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) OA are randomly assigned (1:1) to receive either partial denervation through neurectomy of the anterior (AIN) or posterior (PIN) interosseous nerves or patient education combined with a self-managed exercise therapy program focused on wrist stability and muscle strength. The primary outcome is the change in the Patient-Rated Wrist Evaluation (PRWE) score at 6 months. Secondary outcomes include wrist range of motion, grip strength, pain levels, survival of the interventions, and quality of life over 12 months.

High-quality evidence regarding the effectiveness of different treatment options in wrist OA is lacking. To our knowledge, this is the first RCT comparing surgical and nonsurgical treatments in wrist OA. Using patient education and exercise therapy as a comparator to partial wrist denervation ensures ethical, clinically relevant care aligning with current OA treatment standards. Ultimately, the findings of this trial will guide and optimize treatment recommendations for wrist OA.

ClinicalTrials.gov ID NCT06098586. Registered on 23 Oct 24.

The online version contains supplementary material available at 10.1186/s13063-025-09241-7.