Home > Arthroscopy > Wrist Arthroscopy

WRIST ARTHROSCOPY

Introduction
o Techniques developed from larger joints
o Labyrinth of bones and ligaments to negotiate
o TF Complex can be evaluated
o Can also be useful in assessing instability

Wrist arthroscopy can be diagnostic in
o Chronic wrist pain
o Chondral defects
o Tears of the TFC (triangular fibro-cartilage)
o Tears of the Interrosseus ligaments (partial or complete)

Wrist arthroscopy can be of therapeutic benefit in
o Fractures of the scaphoid and the distal radius
o Stabilisation of the interosseus ligaments
o Debridement of the tears of the triangular fibro-cartilage (TFC) and repair of them
o Synovectomy
o Distal ulnar shortening
o Loose bodies
o Ganglionectomy
o Wrist lavage

Set-up for Wrist Arthroscopy
o Traction via finger traps. 4-5 kg
o Counter balance
o Small scope - 2.7 mm, 2.9 mm, 30 - 70 degree angle

Portals
o It is important to mark all the relevant landmarks
o The ¾ portal is usually the viewing portal
o The 4/5 or 6R portals can be the working portals
o The 6U portal, can be the inflow portal
o The mid carpal portal

Examination during wrist arthroscopy
o Can be begun by starting from the lateral side and moving towards the ulnar aspect
o Examine the radial styloid, scaphoid, RSC ligament, long radio-lunate ligament, scapho-lunate ligament, articular disc of TFC - check for trampolining - to determine if TFC is torn.
o Switch scope to 4/5 or 6R portal to view the ulno-carpal ligaments and luno-triquetral ligaments
o Switch scope to mid-carpal space and view the, scapho-lunate and the luno-triquetral ligaments, to probe for instability
o Usually there is no step off at the scapho-lunate space, but a 1mm step-off at the Luno-triquetral space

o Wrist Arthroscopy is thus a very essential tool in the diagnosis and treatment of the various problems that are likely to occur in the wrist.