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.
When is wrist arthroscopy performed?
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, a cartilage structure that provides support in 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 fractures
and arthritis of the wrist.
A small camera fixed to the end of a narrow fiber-optic
tube (2.0mm- 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 protective bandage or wrist splint that allows full mobility of your fingers. The period of protection 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.
and limitations 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.
Figure 1: The wrist is a complex joint made up of many
bones and ligaments, which hold the bones together.
Figure 2: 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.
Figure 3: Introducing the instruments on the back
of the hand, the surgeon can view and subsequently operate on the cyst without a large incision.
© 2011 American Society for Surgery of the Hand. Developed by the ASSH Public Education Committee