Good Reasons To Scope the WristThere are some surgical procedures that can be done either arthroscopically or through a normal incision. However, some are best accomplished through the use of an arthroscopic approach.
Probably the best reason to consider an arthroscopic wrist procedure, compared to a traditional open surgery, is to surgically address cartilage problems, including damage to the triangular fibrocartilage complex (TFCC). The TFCC is a wedge of cartilage, much like the meniscus in the knee, that is important to wrist stability and motion. Damage to the TFCC can cause pain, swelling, and clicking sensations.
Treatment of TFCC tears is often best accomplished arthroscopically, and probably the best reason to consider an arthroscopic approach to the wrist joint. Smaller TFCC tears can be trimmed, while larger TFCC tears will usually be repaired.
Possible Reasons For Wrist Arthroscopy
- Treatment of Ligament Injuries/Instability
Ligament injuries of the wrist can be difficult to assess without visually inspecting the ligament. An arthroscopic procedure can help define the extent of ligament injury. If ligament damage is found, then surgery may require a larger incision to repair the ligaments.
- Treatment of Specific Types of Wrist Fractures
Wrist fractures that mostly involve the cartilage of the wrist joint (rather than bone further away from the joint) can be treated with wrist arthroscopy. Some surgeons may choose to use the camera to visually inspect the cartilage of the joint to ensure it is lined up perfectly. Only a small percentage of wrist fractures require the use of arthroscopy to aid in their treatment.
- Treatment of Ganglion Cysts
Some surgeons are choosing to treat ganglion cysts arthroscopically. Most ganglion cysts develop from the capsule surrounding the joint, and the cyst itself is filled with joint fluid. By addressing the cyst from the source of the problem, some surgeons feel they can lower the chance of the ganglion cyst coming back.
Wrist Arthroscopy May Not Always Be BestNot every cause of wrist pain can be helped with an arthroscopic procedure. Furthermore, some of these procedures are uncommon and should only be performed by surgeons who routinely perform wrist arthroscopy. If you have questions about whether or not wrist arthroscopy may be appropriate for your condition, you should discuss this with your doctor.
Performing Wrist ArthroscopyThe surgical procedure to perform a wrist arthroscopy can either be done under a general or regional anesthesia. After adequate anesthesia, your surgeon will create 'portals' to gain access to the wrist joint. The portals are placed in specific locations to minimize the potential for injury to surrounding nerves, blood vessels, and tendons. Through one portal, a camera is placed into the joint, and through others, small instruments can be used to address the problem.
The length of the wrist arthroscopy procedure varies depending on what your doctor needs to accomplish. After surgery, a soft bandage or splint will be placed. Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what is performed at the time of surgery.
Possible complications of wrist arthroscopy include nerve injury, tendon injury, infection, and reflex sympathetic dystrophy.
Gupta R, et al. "Wrist Arthroscopy: Principles and Clinical Applications. J. Am. Acad. Ortho. Surg., May/June 2001; 9: 200 - 209.