ARTHROSCOPY OF
WRIST
Wrist
arthroscopy has been rapidly evolving over the past 25 years from an
experimental diagnostic instrument to a powerful tool for both accurate
diagnosis and treatment of numerous ailments. Advances in camera technology,
small instrument design, safe portal identification, and, most importantly,
surgeon experience and comfort have all played a role in the development of
this treatment modality.
Currently, wrist arthroscopy is
considered the gold standard for evaluating and often treating chronic wrist
pain. TFCC injuries are a common cause of chronic ulnar-sided wrist pain. Wrist
arthroscopy allows accurate identification of these injuries, determination of
central versus peripheral injury, and treatment. Central TFCC tears cause
painful clicking and catching in the wrist and can be debrided arthroscopically
back to a stable rim of tissue. Peripheral detachment of the TFCC from the
distal ulna causes ulnar-sided wrist pain with potential instability of the
DRUJ and can be successfully treated with the arthroscopic passage of sutures
and secure repair with gratifying results. Radiocarpal and midcarpal
synovectomy, ganglion excision, scapholunate and lunotriquetral tear
debridement versus repair, and loose body removal can also all be successfully
treated arthroscopically. Arthroscopic visualization of both distal radius and
scaphoid fracture fixation has also been reported as an adjunct to standard
treatment, allowing direct visualization of intra-articular reduction and
fixation.
Wrist arthroscopy requires a thorough
understanding of wrist anatomy to allow safe passage of instrumentation and
recognition of the anatomy and pathologic processes encountered. Arthroscopic
portals are identified by their relationship to the numbered extensor tendon
compartments along the dorsum of the wrist. The standard viewing portal is the
3-4 portal, with supplemental portals for instrumentation often occurring at
the 4-5 interval or on either side of the extensor carpi ulnaris tendon (6R and
6U). Midcarpal arthroscopy is a critical component to any diagnostic wrist
arthroscopy. The midcarpal viewing and working portals allow accurate
evaluation and grading of both scapholunate and lunotriquetral instability.
More advanced arthroscopists have utilized both palmar portals and DRUJ portals
for nhanced viewing of complex intra-articular ailments.
