Definition and Overview

Wrist arthroscopy can be either a diagnostic or surgical procedure; it can be performed to diagnose, treat, repair, or manage any problem involving the wrist. It is conducted using an instrument known as arthroscope, a flexible narrow tube that is equipped with a camera that provides real-time images of the wrist and its various parts, such as the tissues, bones, and joints. The procedure is often performed by an orthopaedic specialist or surgeon.

Injuries to the wrist have become one of the leading joint-related problems in the United States. According to the Bureau of Labor and Statistics, there were at least 185,000 cases of occupational injuries affecting the wrists and hands in 2012 alone. More than 30,000 of them were caused by sprains and tears while 17,000 were due to fractures.

Usually an outpatient procedure, wrist arthroscopy doesn’t require general anaesthesia. Also, since only small incisions are made, recovery is quicker and easier while the risks and complications are often minor and rare.

Who Should Undergo and Expected Results

People who are involved in jobs that require consistent or regular use of the hands, fingers, and wrists are possible candidates for the procedure. These include workers who spend a lot of time typing on keyboards as they are prone to developing carpal tunnel syndrome.

Patients who were diagnosed with sprains, tears, and fractures can also be treated with wrist arthroscopy.

Any pain or discomfort felt on the wrist may be checked using this method. This is especially necessary if the pain continues despite medications and other treatments employed. Sometimes standard X-rays cannot catch issues, so the best way to determine is to look inside the wrist. The doctor may also request the exam if previous tests are inconclusive or if more information is needed to make an accurate diagnosis.

Certain types of infection on the limbs can have an impact on the wrist, and the test can indicate the extent of the condition as well as help surgeons determine the most appropriate form of treatment.

Other candidates for this procedure are people who develop ganglion, which are small sacs filled with fluid. Although they are benign, they can cause wrist pain and thus, have to be removed.

The procedure doesn’t take more than an hour to complete. Right after the procedure, the patient’s wrist is bandaged to restrict its motion, although fingers should still be free to move. Depending on the severity of the procedure and the condition, therapy or rehabilitation may follow as soon as the wrist has completely healed. Meanwhile, the doctor may provide medications for pain relief during the recovery stage.

How Does the Procedure Work?

Wrist arthroscopy can be divided into two parts. The first part is the diagnostic wherein the doctor reviews the patient’s concerns, symptoms, and medical history. Other tests, such as wrist rotation, may also be performed if more information is needed before the surgeon can decide if wrist arthroscopy is needed. If it is, local anesthesia is applied to the arm and wrist. Depending on the patient's anxiety level, the surgeon may also elect to provide sedation.

At least two incisions are made on the wrists. This is where the arthroscope is gently inserted. Meanwhile, the camera attached to the probe sends live feedback to the computer screen. The doctor can then discuss the condition based on observations from the test to the patient during the procedure.

At this point, the doctor has the option to end the test and prescribe non-surgical treatment, such as when the cause of the pain is an infection. Otherwise, the second step begins, which is surgery.

Surgery can be performed to repair fractures, align joints and bones, fix tears of the ligaments, and free pinched nerves as in the case of carpal tunnel syndrome. Cysts can also be removed in the process. If there are already damaged tissues, they will also be removed. The scope can go through tissues so it can carry out more intensive surgery using miniature tools.

After the surgery has been completed, the incisions will be stitched, and the wrist is covered with bandage.

Possible Risks and Complications

Risks and complications due to the procedure are not usual. If they occur, they are often minor and gradually disappear a few days after the procedure.

Often, patients will experience wrist stiffness and discomfort due to the bandage that restricts movements. Because of the incisions, the wrist can also be prone to infection. In rare cases, wrist arthroscopy leads to damage to the nerves, cartilages, and tendons.

References:

  • Osterman AL, Lincoski C. Wrist Arthroscopy. In: Skirven, TM, Osterman AL, et al, eds. Rehabilitation of the Hand and Upper Extremity. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011:chap. 77.
  • Part SJ III. Wrist. In: Wolfe SW, Hotchkiss RN, Kozin SH, Pederson WC, eds. Green's Operative Hand Surgery. 6th ed.Philadelphia, PA: Elsevier Churchill-Livingston; 2010:chap 14.
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