Arthroscopy of the wrist

Arthroscopy is a surgical procedure used by orthopaedic surgeons to diagnose and treat problems inside a joint. The wrist is a complex joint with eight small bones and many connecting ligaments.
Arthroscopy allows the surgeon to visualize anatomical parts and their movements without making large incisions in the muscles and tissues.
An arthroscopy is used for two reasons: for a more precise diagnosis (diagnostic arthroscopy) and to treat various joint conditions.

Arthroscopic surgery is a valuable diagnostic and treatment tool. Because it requires fewer small incisions, patients generally have fewer complications and a faster recovery than after open surgery.

Technical

Surgeons make portals/incisions in specific places on the wrist, depending on the area to be visualized. This set of portals, called standard radiocarpal portals will provide access to the wrist. Other sets of portals provide access to other areas of the mine.
The surgeon makes small incisions through the skin in places around the joint.

Through these incisions, the pencil-sized arthroscope with a small lens at one end, a miniature camera and a lighting system is inserted.

Three-dimensional images of the joint are projected through the camera onto a high-definition monitor. The surgeon follows every movement the arthroscope makes inside the joint on the monitor.

Arthroscopic diagnosis

Diagnostic arthroscopy may be used if the cause of wrist pain is unclear. It could also be used if wrist pain persists for several months despite non-surgical treatment.

Before arthroscopic surgery, your doctor will do the following:

1. clinical examination of the hand and wrist

2. detailed anamnesis

3. performing tests, which would localize the pain (provocation tests). These tests involve moving the hand in order to reproduce the pain.

4. imaging investigations, which may include radiographs, magnetic resonance imaging, or X-rays with contrast injected into the joint.
Usually, arthroscopic surgery only requires that part of the arm be numbed (regional anesthesia). A sedative may be given to the patient for relaxation.

Two or more small incisions (portals) are made on the back of the wrist. The arthroscope and instruments are inserted through these portals to visualize the joint.
After surgery, the incisions are closed with a small suture and a dressing is applied. Sometimes a splint is used to protect the joint.

Arthroscopic surgical treatment

Arthroscopic surgery can be used to treat a number of conditions of the wrist. These include chronic (long term) wrist pain, fractures, ganglion cysts, ligament injuries, and triangular fibrocartilaginous complex (TFCC) injuries. Wrist arthroscopy can also be used to smooth bone surfaces and remove inflamed tissue.

– chronic wrist pain: exploratory arthroscopic surgery may be used to diagnose the cause of chronic pain, if the results of other tests do not provide a clear diagnosis. Often, there may be areas of inflammation, cartilage damage, .
– wrist fracture: small bone fragments may remain in the joint after a fracture.Arthroscopy of the wrist can remove these fragments, align the pieces of bone, and stabilize them using pins, wires, or screws.
– Ganglion cysts:
– ligament / triangular fibrocartilaginous complex (TFCC) lesions: ligaments are bands of fibrous connective tissue that connect the bones (hinge). They provide stability and support for joints. The TFCC is a cushioning structure in the wrist. A fall can tear the ligaments, the TFCC, or both. The result is pain on movement or a feeling of joint noise (crackling). During arthroscopic surgery, the surgeon can repair the ligament.
– carpal tunnel release: carpal tunnel syndrome is characterized by numbness or tingling in the hand, and sometimes with arm pain. It is caused by increased pressure on a nerve passing through the carpal tunnel. This pressure in the tunnel can occur for a number of reasons, including irritation and swelling of the (synovial) tissue that covers the tendons. If carpal tunnel syndrome does not respond to non-surgical treatment, one option is surgery.

After surgery

For the first two to three days after surgery, the wrist should be held in an elevated position. The bandage should be kept clean and dry. Ice can help keep the wrist from swelling. There are exercises that can be used to help the wrist recover. Although pain after surgery is usually mild, painkillers may be given to relieve it.