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Wrist Arthroscopy
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, which hold the bones together (see Figure
1). Wrist arthroscopy allows the surgeon to diagnose and treat many problems
of the wrist through a series of very small incisions (portals). In the
last 5 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 often faster.
Wrist arthroscopy allows
the visualization of the cartilage surfaces of all bones in the wrist
and better evaluation of the ligaments between the various bones of the
wrist. Frequently after an injury, pain, clicks, and swelling may be
indicative of an internal problem in the wrist. Arthroscopy is often
the best way of assessing the integrity of the ligaments, cartilage,
and bone. When wrist problems are encountered, many are treated through
these small incisions using specialized equipment available for wrist
arthroscopy. Often arthroscopy is used to aid in the reduction of fractures
of the bones of the wrist. Wrist arthroscopy is also used to assess the
integrity of the TFCC (triangular fibrocartilage, or meniscus of the
wrist). Today, wrist arthroscopy can even be used to remove some ganglions
of the wrist and to assess the extent and treatment of various types
of arthritis of the wrist.
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 (see Figure 2). The camera lens magnifies and projects
the small structures in the wrist onto 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 (see Figure 3). The wrist is usually 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
procedures.
After your arthroscopy you will
most likely 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.
As with any surgery,
wrist arthroscopy has risks. These include infection, and potential damage
to nerves and tendons (usually less than 1%). Stiffness might need to
be addressed through post-operative rehabilitation. Wrist arthroscopy
is not appropriate for all wrist conditions and is dependent on the surgeon’s
training, expertise and comfort level.
The wrist is a complex
joint made up of many bones and ligaments, which hold the bones together.
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.
Introducing the instruments on the back of the hand, the surgeon
can view and subsequently operate on the cyst without a large incision.
© 2007 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee
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