Wrist arthroscopy is a minimally invasive surgical procedure which allows access to both parts of the wrist (radio-carpal and mid carpal joints) as well as the thumb carpo-metacarpal and distal radio-ulnar joints.
Under a block or a general anaesthetic, the patient’s wrist is gently distracted to create space between the joint surfaces. It is my preference to avoid the use of fluid distension, to minimise swelling from the procedure.
A miniature arthroscope (1.9mm diameter) is then carefully introduced into the wrist through a tiny incision (2-3mm). A fiberoptic cable carries bright light from a source to the tip of the arthroscope and into the wrist joint. A video camera at the head of the scope captures the view from inside the wrist and transmits it to the screens in the operating theatre. Tiny probes and other instruments are introduced into the wrist through other portals, allowing a real-time assessment of the joint structures with beautiful magnified images. When it comes to definitively assessing wrist joint problems, arthroscopy is the “gold standard”.
By allowing access to the interior of the wrist, with minimal disruption of normal anatomy, wrist arthroscopy has the potential to be of enormous benefit to surgeons and their patients. I see wrist arthroscopy as being an incredibly powerful tool for wrist surgeons. The impact of this technology has begun to change what is possible, and as techniques and equipment evolve, it is not difficult to imagine that wrist arthroscopy will become an integral part of wrist surgery. For me and some other wrist surgeons, it already is!
Initially, wrist arthroscopy was used as a diagnostic tool, and for relatively simple procedures, such as “debridment” or cleaning up, of cartilage fraying or inflamed joint tissue (synovectomy).
I currently use arthroscopic techniques for the following surgeries:
- arthroscopic scaphoid bone grafting and percutaneous fixation (for non-union)
- arthroscopic assisted percutaneous screw fixation of scaphoid fractures
- arthroscopic assisted reduction and fixation for intra-articular distal radius fractures
- arthroscopic scapho-lunate repair and reconstruction
- arthroscopic assisted partial wrist fusion
- arthroscopic proximal row carpectomy
- arthroscopic radial styloidectomy
- arthroscopic ganglionectomy – dorsal and volar
- thumb CMCJ arthroscopic synovectomy and loose body removal
- arthroscopic assisted reduction and fixation of Bennett’s fractures (thumb CMCJ)
- arthroscopic dorsal capsular repair
- arthroscopic bone grafting of wrist bone cysts