Partial wrist denervation (PIN/AIN neurectomy)

By Dr Maxime Cievet-Bonfils, hand, wrist and elbow surgeon in Lyon, France · Updated 2026-10-16 · Version française

Partial wrist denervation consists of cutting two small, deep nerves that carry a large part of the pain from the joint: the posterior interosseous nerve (PIN) and the anterior interosseous nerve (AIN). It is mainly used in wrist arthritis. It is a short procedure, done as a day case, which reduces pain while keeping the movement and strength of the wrist, with no immobilisation, and which does not rule out any later operation.

What is wrist denervation?

The wrist joint is supplied by many small nerve branches that carry pain. Two of them, lying deep against the membrane that connects the radius and the ulna, play an important role:

• the posterior interosseous nerve, on the back of the wrist
• the anterior interosseous nerve, on the front of the wrist

At wrist level, these end branches are sensory nerves for the joint: they do not provide feeling to the skin of the hand and do not control the fingers. Cutting them reduces joint pain with no loss of feeling in the hand and no noticeable loss of strength.

Denervation does not treat the cause of the pain: it does not repair the cartilage and does not stop the wear. Its aim is to make the joint less painful.

In which situations?

• Radiocarpal arthritis, particularly after an old ligament injury or a scaphoid nonunion, when pain is the main problem and movement is preserved
• Distal radioulnar arthritis (the joint between the radius and the ulna, at the wrist)
• Kienböck's disease, on its own or combined with another procedure
• Some chronic wrist pain after a fracture or a severe sprain
• In addition to another wrist operation (partial fusion, proximal row carpectomy)

What are the advantages?

• Movement is preserved: no joint is fused
• No immobilisation: the wrist is used from the following days
• Quick recovery: return to everyday tasks within a few days, and to most activities within a few weeks
• A short procedure, through a single incision on the back of the wrist, as a day case
• No door is closed: if the pain comes back as the arthritis progresses, a partial fusion, a proximal row carpectomy or a joint replacement remain possible

How can you tell whether it is likely to work?

Before the operation is offered, an anaesthetic test is carried out: an injection of local anaesthetic, guided by ultrasound, next to the interosseous nerves. If the pain clearly decreases over the following hours, denervation has a good chance of providing relief; if not, it is not offered.

How is the operation performed?

Through a single short incision on the back of the wrist, a few centimetres above the joint, the surgeon locates the posterior interosseous nerve, then reaches the anterior interosseous nerve through the interosseous membrane, with no incision on the front of the wrist. A small segment of each nerve is removed. The operation is short and is done as a day case, under regional anaesthesia of the arm.

After the operation

• No immobilisation: a simple dressing is kept on until the wound has healed, usually two weeks
• Everyday tasks are resumed from the first few days
• Return to strenuous effort is gradual over a few weeks

Complications are rare: haematoma, tender scar, complex regional pain syndrome. They are explained to you in consultation.

Frequently asked questions

Does denervation get rid of all the pain?

Not always. It reduces pain in most patients, but the relief is often partial and may fade as the arthritis progresses. In a review of the literature, about eight patients out of ten were relieved without further surgery, with an average follow-up of about two years (EFORT Open Rev 2023).

Will I lose strength or feeling?

No. The branches that are cut are deep and supply the joint: feeling in the skin of the hand and strength in the fingers are preserved.

Can I still have surgery after a denervation?

Yes. Denervation does not alter the joint: a partial fusion, a proximal row carpectomy or a joint replacement remain possible if the pain comes back.

Why not cut all the nerves of the wrist?

So-called total denervation, which cuts many branches, requires several incisions and a longer recovery. Partial denervation of the interosseous nerves is simpler and gives similar results in the literature.

This page provides general information. It does not replace a consultation: every situation is different.