Wrist arthroscopy is an advanced surgical procedure offering less risk to patients and usually remarkable recovery. The word “arthroscopy” comes from the Greek words “arthros” (joint) and “scopos” (to look). In today’s terms, it is a surgical procedure which allows surgeons to view the inside of joints and the spaces surrounding them, through small ‘key holes’ in order to detect and treat damaged tissue. An arthroscope is a thin (3mm) instrument with fibre-optic fibres. These fibres beam light into your joint and project a picture to a television monitor in front of us similar to watching a live programme on television.
During wrist arthroscopy, the arthroscope is placed into the wrist joint through a small incision or “portal” on the outer surface. At least one other small incision or portal is made as well, which will allow us to insert other instruments that can help identify and treat the problem.
Because wrist arthroscopy requires only small incisions, most patients recover more quickly and with less post-operative pain than with open surgery. Usually all wrist arthroscopies are performed as day-case surgery.
When is a wrist arthroscopy necessary?
During the consultation we will examine your wrist after taking a careful history of your problem(s). You can help us arrive to the right diagnosis by describing the type and severity or limitation you experience with each portion of the examination. Usually we will have a good idea about your problem but we may order additional studies to confirm the diagnosis. This can include x-rays and laboratory tests. Special studies such as stress x-rays, CT scans, MRI scans and bone scans may also be ordered to further clarify the diagnosis and plan treatment. It may be possible to treat your condition entirely by arthroscopy so recovery will be quicker. However, occasionally it is very difficult to reach a diagnosis and we may want to have “a look” in your wrist (diagnostic arthroscopy). Depending on what is found we can either treat it then and there or more often, plan another operation after discussing the treatment options with you. This allows you to schedule the operation and subsequent post-operative rehabilitation that suits you.
What conditions can we treat using wrist arthroscopy?
Triangular fibrocartilage (TFCC) tears.
The TFCC is an important structure in your wrist that may be damaged due to injury to the wrist or as a result of overuse. When physiotherapy and other treatments do not work, the arthroscope can be used to evaluate the extent of the damage and remover cartilage or even assist in repairing some tears. This depends on where the tear is and how old it is, and, if it is at all reparable.
Injuries to the wrist such as falls may cause wrist ligaments to tear. Some ligaments may need repair but sometimes may be difficult to see definitely on any scans you have had. In order to assess the extent of the damage and to see if repair is necessary or possible, a wrist arthroscopy can be extremely useful. Once the ligament(s) injury has been found we can discuss the further surgical treatment with you on the day or at the clinic. This will often require an open procedure which can be performed at the same time or done as a second operation.
Wrist synovitis/arthritis or cartilage damage
A number of conditions may cause irritation or wrist joint degeneration leading to pain, swelling and loos of function. Arthroscopic removal (debridement) of irritated tissue, loose pieces of cartilage and occasionally bone spurs inside the wrist joint may help reduce wrist pain and swelling, and improve motion. If you have wearing down of the cartilage (arthritis), we can shave off or smooth the worn area. Bone or cartilage fragments that have chipped off in the joint will then be removed. This can help to provide a smooth, pain-free movement. It will not stop the arthritis from progressing if it is part of a general disease such as, rheumatoid arthritis.
If the ulna-impaction is due to a minor increase in ulnar length then this can be addressed by arthroscopic shaving or removal of just enough cartilage and bone to stop it from impinging in the wrist. This often allows you to rotate your wrist without pain and is called the “wafer procedure” because only a small wafer of bone is removed arthroscopically.
What happens during and after surgery?
Once your wrist is numb or you are asleep, we will use a scalpel to make two or three small incisions on your wrist. These portals will allow us to perform the surgery. Occasionally your wrist may be moved to open spaces between the joint surfaces. This will help us see better and complete the surgical procedure.
The incisions are usually closed with a small bandage or single suture. They will heal quickly because they are so small. Arthroscopic surgery does not require as much recovery as open surgery and you can usually go home on the same day. You may experience some swelling and discomfort during the first few days after the operation, and your activity may be temporarily restricted. Pain medication will usually be provided for you and cold dressings may help to alleviate the pain as well as keeping your hand elevated. You can usually return to work or school in a few days depending on the pathology that was found or treated and with modifications as advised by us. We may start you on a physiotherapy course if necessary which will be discussed with you at the clinic appointment. Understanding the risks of wrist arthroscopy! All operations, including arthroscopic procedures, have limits as to what can be accomplished. While most arthroscopic procedures usually follow a good recovery, it is possible that your wrist continues to give you problems after surgery. As with any surgical procedure, there are potential risks and complications. They do not occur very often in arthrosopic procedures, but some of the more common ones are: anaesthetic, infection, excessive bleeding or swelling, instrument breakage, nerve damage or persistent pre-operative symptoms due to the underlying disease.