Wrist Arthroscopy

What is it?

Arthroscopy is a minimally invasive technique of visualizing the inside of a joint.The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The wrist is a complex joint made up of many bones and ligaments that hold the bones together (see Figure 1).Wrist arthroscopy allows the surgeon to diagnose and treat many problems of the wrist through very small incisions. In recent years, the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder. Because the incisions used with wrist arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized and recovery is faster.

When is Wrist Arthroscopy Performed?

The most common reason for performing wrist arthroscopy is to evaluate and treat injuries to the triangular fibrocartilage. This structure in the ulnar (little finger) side of the wrist is difficult to visualize through open surgery and is best visualized and treated arthroscopically. Treatments can include removing damaged tissue and/or repair of the structure. Arthroscopy is often the best way of assessing and treating injuries to ligaments, cartilage and bone within the wrist joint itself. Other specific conditions that do well with arthroscopic treatment include injuries to the scapholunate and lunotriquetral ligaments and some wrist fractures. In some cases of fracture of the distal radius or of the scaphoid, arthroscopy treatment is possible. Patients who have had prolonged pain in the wrist, particularly on the ulnar side of the wrist, and have not done well with other treatments may be candidates for arthroscopic evaluation of the wrist joint. In this case, if significant pathology is found, then it can be treated arthroscopically at the same time.

How is it Performed?

As Figure 2 illustrates, a small camera fixed to the end of a narrow fiber-optic tube (2.7mm wide) is inserted through a small incision in the skin (about 5mm long) directly into the back of the wrist joint.The camera lens magnifies and projects the small structures in the wrist on to a television monitor, allowing for more accurate diagnosis. Several small incisions (portals) are used to allow the surgeon to place the camera in different positions to see different structures inside the joint, as well as to place various small instruments into the wrist joint to help diagnose and treat various problems in the wrist.The wrist is distracted and fluid is infused into the joint to expand the joint and allow improved visualization during the procedure. Sometimes wrist arthroscopy is combined with open surgical procedures (see Figure 2).

After Wrist Arthroscopy

After your arthroscopy you will be placed into a wrist splint that allows full mobility of your fingers. The period of immobilization will vary depending on what was performed at the time of surgery. Elevating the involved extremity is important to prevent excessive swelling and pain after your surgery.

Because the wrist arthroscopy is minimally invasive, the recovery is generally simple and faster than after open surgeries. If substantial repairs have been done arthroscopically then the wrist may need immobilization for four to six weeks. If arthroscopy is used only for removing damaged tissue, early action motion is usually possible within a week after the surgery.