Introduction:
Hand and wrist injuries are common. There could be various causes of wrist problems, such as fallen wrist, twisted wrist, clicking in the wrist, pain, swelling, and other more complicated and severe conditions such as ligament injuries, out of which triangular fibrocartilage complex (TFCC) tear and damage are common. Most injuries or pathologies can be treated through non-surgical therapy such as physiotherapy, medications, etc. When these treatments fail, they may require a surgical approach.
Wrist arthroscopy is one of the old techniques used to treat and diagnose various wrist-related pathologies. A fiber-optic camera with a light is the main tool or instrument used in this procedure. This camera is called an arthroscope. There are various advantages of this procedure over traditional open surgery, but the biggest disadvantage is arthrofibrosis - a fibrotic joint disorder resulting in joint stiffness and restricted movement.
What Is Arthroscopy?
Arthroscopy is a diagnostic and therapeutic technique that is used in joint-related conditions of the human body. A fiber-optic video camera is inserted into the affected area, the internal structures are displayed on the screen, and the surgery is performed. Any arthroscopy in any joint is commonly referred to as keyhole surgery.
What Is Wrist Arthroscopy?
It is a diagnostic and therapeutic procedure for different wrist-related pathologies such as septic arthritis(An infection in the joint tissues and synovial fluid causes septic arthritis.), synovial proliferation(Excessive growth of synovial tissue), distal ulnar shortening(a surgical procedure that involves reducing the length of the ulna bone in the forearm), etc. Different wrist pathologies and problems are treated surgically through a fiber optic camera - arthroscope.
When Is an Arthroscopy of the Wrist Necessary?
Wrist arthroscopy is performed:
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When other diagnostic examinations such as patient history, physical examination, or imaging tests have failed to detect any problem.
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To know the severity of the lesions.
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To establish the nature or type of the pathology in the wrist.
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To guide further treatment.
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To check the alignment of wrist fracture.
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To remove or wash out the infection.
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To remove ganglions of the wrist.
What Does Wrist Arthroscopy Treat?
It can treat wrist-related pathologies such as -
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Triangular Fibrocartilage Complex (TFCC) Tear and Damage - It is made of ligaments, tendons, and cartilage that connect the forearm with the wrist. When the wrist is fractured, twisted, or injured, the ligaments and tendons of this complex get damaged and torn.
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Arthritis - It is swelling and tenderness of the human body joints. The joints in the wrist may become swollen.
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Ulnar Impaction Syndrome - It is a degenerative condition that causes ulnar-sided wrist pain. There is swelling, and the forearm and wrist movement becomes limited.
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Instability of the Carpal Bone - In this condition, the wrist fails to maintain the stability of the hand during movement and forces. This causes disturbed alignment and derangement of the carpals. It also causes early arthritis of the joints.
What Is the Other Name for Wrist Arthroscopy?
Any arthroscopy in any joint is commonly referred to as keyhole surgery. Arthroscopy is a surgical technique employed for the purpose of both diagnosing and treating issues within a joint.
What Is the Wrist Anatomy Involved in Wrist Arthroscopy?
The one side of the wrist has two rows of bones. Each row has four bones - carpals. The human hand carpus is made of eight bones placed in two rows - distal and proximal. The proximal row can be accessed easily in wrist arthroscopy. It consists of the scaphoid, lunate, triquetrum, and pisiform. The wrist arthroscopy consists of the ulnocarpal joint and radiocarpal joint. The ulnocarpal joint consists of a triangular fibrocartilage complex - which provides stabilization to the wrist joint.
What Is Wrist Arthroscopy Surgery?
The surgery is performed in an operating room, and local anesthesia is given to the patient. The patient stays in a supine position, and the wrist where the surgery needs to be done is placed on the wrist table. A traction device is attached with up to 10 lbs of traction - a device used to put tension on the joint to create space between the bones and to create more space for easy Post-surgery. An ice pack for four portals is established. A 22-gauge needle is inserted, and five to ten ml of saline is injected into the joint. The needle is pulled out, and an incision is made. An arthroscopic cannula with a trocar is inserted at a 10-degree angle and is removed. A 2.7 mm arthroscope is inserted at an angle of 30 degrees into the cannula. After establishing three to four portals, the surgeon may establish other portals by repeating the same procedure, such as 6-U, one to two portals. After establishing all the portals, the required treatment is performed, such as debridement, repair.
What Are the Complications of Wrist Arthroscopy?
The complications of Wrist arthroscopy are rare. A few common possible complications are:
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Stiffness of wrist joint. Arthritis often presents with discomfort and pain as typical symptoms.
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Ganglion cyst development - A ganglion cyst is a small fluid-filled lump present under the skin. It frequently develops on the backside of the wrist. It may change in size, cause pain, and interfere with normal functions. If the cyst causes pain and discomfort, it may require a non-surgical or surgical treatment.
How Long Does Wrist Arthroscopy Take?
The arthroscopy surgery is a day treatment; it is performed under general anesthesia. The duration of the process will vary between 30 minutes to an hour, depending on the findings of the initial visual examination, such as the index pathology for which arthroscopy is performed.
The patient will remain conscious throughout the operation; they are provided with thorough care and attention to ensure complete comfort and relaxation.
How Large Are the Average Incisions in a Wrist Arthroscopy?
The physician will create one or two small incisions, measuring half an inch long, on the posterior aspect of the wrist, which are referred to as portals. The portals are strategically positioned on the wrist based on the exact regions that require visualization. The arthroscope and specialized surgical equipment are introduced into the wrist through these openings.
How Long Does It Take To Recover From Wrist Arthroscopy?
It takes six weeks to recover from wrist arthroscopy. The incisions made on the wrist during surgery may heal in one to two weeks. The overall recovery of the patient depends on the type of treatment and other factors, such as internal damaged tissues, which may take a longer time to heal.
What Is Wrist Arthroscopic Triangular Fibrocartilage Complex (TFCC) Debridement?
When the non-surgical treatments fail, a therapeutic arthroscopy surgery is performed to stabilize the distal ulnar joint associated with triangular fibrocartilage complex tears. These tears cause pain in the wrist and are a common condition.
What Is Wrist Arthroscopy Post Operative Care?
Post-surgery care includes an icepack application on the surgery site or wrist. After surgery, inflammation, redness, and swelling are common signs that may disappear in a few weeks. To reduce these signs, an icepack can be applied. Minimal exercise is advised to maintain the movement of the fingers and wrist. For up to 14 days after surgery, the hand and wrist must be kept elevated with limited activities.
Conclusion:
Wrist arthroscopy is an effective method used for diagnostic and therapeutic purposes. After this surgery, the patient is able to resume everyday life activities such as desk work, driving, etc. The video camera attached to a narrow pencil-like tube or cord allows the doctor to view the internal structures on the screen or monitor. It is a less invasive technique and has a fast recovery time.
