The wrist is a complex joint made up of eight small bones and many connecting ligaments. Arthroscopic surgery can be used to diagnose and treat a number of conditions of the wrist, including chronic wrist pain, wrist fractures, ganglion cysts and ligament tears.
In the last several years, the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder.
Arthroscopy is a minimally invasive technique used to visualize the inside of a joint. An arthroscope is a valuable tool for accurate diagnosing and treating any problems with the joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). Arthroscopy allows the surgeon to examine the intricacies of the wrist without having to make large incisions into the muscle and tissue.
During the arthroscopic procedure, the surgeon makes small incisions (called portals) through the skin in specific locations around a joint. These incisions are less than half an inch long. The arthroscope, which contains a small lens, a miniature camera and a lighting system, is inserted through these incisions.
The three-dimensional images of the joint are projected through the camera onto a television monitor. The surgeon watches the monitor as he moves the instrument within the joint. Probes, forceps, knives and shavers at the ends of the arthroscope are used to correct problems the surgeon discovers.
Over the last 20 years, the use of wrist arthroscopy in both the diagnosis and treatment of problems in the wrist has grown tremendously. For those who have experienced wrist pain for several months without a known cause, or following failure of nonsurgical treatments for a period of time, diagnostic arthroscopy is an option. A systematic arthroscopic examination can locate and confirm defects in the wrist joint that may be missed by other more standard diagnostic techniques, such as arthrograms and MRI. In some cases, following the diagnosis, the condition can be treated arthroscopically as well.
Arthroscopic Surgical Treatment
Arthroscopic surgery can be used to treat a number of conditions of the wrist. These include synovial biopsy (a sample of joint tissue for lab analysis), synovectomy (removal of the inflamed tissue that is causing pain and joint damage) and to treat instability, lesions, fractures and ganglion cysts.
In the case of fractures, small bone fragments may remain in the wrist after a break. Wrist arthroscopy can remove these fragments, correct the alignment of broken pieces of bone and if necessary, stabilize them by using hardware (i.e. pins, wires or screws).
Ligaments are fibrous bands of connective tissue that link or hinge bones. They provide stability and support to the joints. The TFCC (Triangular Fibrocartilage Complex), which is approximately the size of a dime, is a cushioning structure within the wrist. Many patients diagnosed with a “wrist sprain” have injury to this ligament. A fall on an outstretched hand can tear ligaments, the TFCC, or both. The result is pain with movement or a clicking sensation. During arthroscopic surgery, the surgeon can repair these tears.
The carpal tunnel is formed by the wrist bones and a thick roof of tissue. Pressure can build up within the tunnel for many reasons, including irritation and swelling of the tissue (synovium) that covers the tendons. Carpal tunnel syndrome is characterized by numbness or tingling in the hand, and sometimes with pain up the arm. It is caused by pressure on a nerve that passes through the carpal tunnel. Arthroscopic surgery may be used to reduce the pressure on the nerve and thus relieve the symptoms.
Because arthroscopy is minimally invasive, patients experience fewer post-procedure problems and recover quicker than with regular surgery. Since it is usually an outpatient procedure, most patients can go home only several hours after surgery.
Following wrist arthroscopy, patients are bandaged and may be put in a splint to keep the wrist straight. As with other surgeries, patients are given postoperative care instructions including a direction to elevate the arm to avoid excessive pain and swelling.
Recovery time varies, depending on what procedure was performed. Recovery may take several days with soft tissue debridement or several weeks or months for fixing fractures, soft tissue repair or reconstruction. Dr. Horowitz’s main priority is to perform the least invasive procedure to garner the most effective results. In this case, the goal is for patients to be returned as quickly as possible to a pain-free, pre-injury status.