Awake Carpometacarpal Denervation for Targeted Pain Relief at the Base of the Thumb Under Local Anesthesia: A Case Report.

Thumb carpometacarpal (CMC) osteoarthritis is a common source of pain and disability. While denervation has emerged as a motion-preserving alternative to arthroplasty, it is typically performed under regional or general anesthesia. We report the case of a 78-year-old male with systemic scleroderma and pulmonary hypertension who presented with progressive left base of thumb pain. He failed conservative measures, including corticosteroid injection, activity modification, and physical therapy. Examination demonstrated tenderness and pain with the CMC grind. Radiographs revealed advanced degeneration of the CMC and radiocarpal joints, though symptoms were isolated to the CMC joint. After multidisciplinary clearance, he underwent awake CMC joint denervation utilizing local anesthesia in the clinic setting. The procedure was conducted safely without complications. He experienced significant pain relief and functional improvement, without complication, at five-month follow-up. This case demonstrates the feasibility and safety of performing awake first CMC joint denervation under local anesthetic can provide effective pain relief in appropriately selected patients with advanced CMC arthritis who are poor candidates for general anesthesia.