Overview of Wrist Arthroscopy
Wrist arthroscopy is a procedure that allows doctors to look inside the wrist joint and treat certain issues. Over time, this procedure has increased in use for both finding and dealing with problems in the wrist and hand bones. Wrist arthroscopy has improved and its uses have expanded since it was first talked about in the late 1970s.
Anatomy and Physiology of Wrist Arthroscopy
The wrist is made up of the radiocarpal joint and the ulnocarpal joint. The hand itself consists of 8 small bones organized in two rows: the closer and farther rows. The closer row, which is often the focus in a wrist procedure called an arthroscopy, includes the scaphoid, lunate, triquetrum, and pisiform bones, which organize from the thumb side to the little finger side. The ulnocarpal joint primarily includes a network of tissues called the triangular fibrocartilage complex (TFCC), which helps keep the wrist stable.
For a closer look at the wrist using a camera (a procedure known as wrist arthroscopy), doctors use specific access points on the back of the hand, called dorsal radiocarpal portals. These are located based on the arrangement of six muscle and tendon groups, known as dorsal extensor compartments.
These compartments vary in their content. The first has the extensor pollicis brevis, a tendon that helps move the thumb, and the abductor pollicis longus, which helps in thumb movement as well. The second compartment has the extensor carpi radialis brevis and longus tendons that help bend the wrist. The third compartment, which curves around a small bump on the back of the wrist called Lister’s tubercle, has the extensor pollicis longus tendon which helps in thumb movement. The fourth compartment has multiple parts of the extensor digitorum communis tendons, which help move the fingers, and the extensor indicis proprius tendon that helps in finger movement too. The fifth compartment contains the extensor digiti minimi tendon that helps move the little finger. Lastly, the sixth compartment, located towards the little finger side, contains the extensor carpi ulnaris tendon that helps bend and move the wrist.
Why do People Need Wrist Arthroscopy
Wrist arthroscopy, a technique used to look inside the wrist joint using a small, tube-like camera, can be used for a variety of problems related to the wrist. These problems can include checking the joint surfaces and ligaments, removing loose bits of bone or cartilage, treating issues with the triangular fibrocartilage complex (TFCC, a cushioning structure within the wrist), addressing instability in the wrist joint, looking at the lower end of the forearm bone (distal radius) or the scaphoid bone in the wrist, reducing fractures within these bones, performing a capsulectomy (surgery to remove the joint capsule), removing a ganglion (a swelling that often occurs on the hand or wrist), and performing a radial styloidectomy (surgery to remove a bone projection on the thumb side of the wrist to ease arthritis symptoms). As technology improves, wrist arthroscopy is being used to treat more and more conditions.
When a Person Should Avoid Wrist Arthroscopy
There are certain situations where wrist surgery using implants such as stitch anchors or suture materials cannot be performed. If there is an active infection in the wrist, it can make the operation a risky idea. Another situation is when there are capsular tears, which means the tough bands of tissue that surround and stabilize the wrist are torn. This could lead to an overload of fluid leaking out from around the wrist area, making the procedure unsafe.
Another condition that makes the situation tricky, but doesn’t necessarily prevent the operation, is having a bleeding disorder. In other words, if a person has a disease that causes issues with their blood clotting properly, it can increase the risk related to the procedure.
Equipment used for Wrist Arthroscopy
When your doctor is performing a wrist arthroscopy, which is a type of minimally invasive surgery that allows a detailed examination of the wrist, certain smaller surgical tools are necessary. A specific tool called an arthroscope, which is a small camera inserted through a tiny incision, is often used. This usually measures 2.7 mm or less and is angled at 30° for the best viewing. Sometimes a 70° arthroscope may be used instead.
The wrist joint is gently stretched or “distracted” using a common tool known as a commercial traction device. It’s also advised to use smaller tools such as joint graspers and shavers (which are used to remove tissue) that measure 3.5 mm or less to adapt to the small size of the wrist.
Your doctor will also need an arthroscopic video monitor to view what the arthroscope sees inside your wrist. This is assisted by an effective light source to brighten the images, and recording equipment to save any significant findings during the procedure for further analysis.
Who is needed to perform Wrist Arthroscopy?
Wrist arthroscopy is a type of surgery that your doctor does on your wrist. It takes place in a special area in the hospital called an operating room. Just like when a team works together to get a job done, different types of medical staff will be there to make sure the surgery goes well.
First, there is the main doctor, or surgeon, who has special training to do this type of wrist surgery. Then, there’s the surgical technician who helps prepare everything for the surgery. A surgical assistant will be there to help the surgeon during the operation. There’s also a circulating nurse who makes sure everything in the operating room goes smoothly. Finally, an anesthetist will be present to help put you to sleep, so you won’t feel any pain during this procedure.
All these people will work together for your safety and to make sure you get the best possible care during your wrist surgery.
Preparing for Wrist Arthroscopy
Before deciding on surgery, doctors must thoroughly assess the condition of the patient’s upper arm. This involves planning ahead of the operation and requires the use of x-rays of the wrist and hand. Advanced imaging techniques, such as magnetic resonance imaging (MRI), may be used to identify injuries to soft tissues in the hand or wrist. This method, called wrist arthroscopy, is used when doctors need a closer look at the affected area.
Choosing the right patient for surgery is also essential in ensuring a positive outcome. Therefore, patients are required to undergo standardized tests before the operation. These tests confirm whether it is safe for the patient to have surgery, and help doctors prepare the patient for the procedure.
How is Wrist Arthroscopy performed
Before heading in for the operation, the anesthesia team might choose to do a regional nerve block. This involves numbing a particular area of your body to help control pain during and after surgery. Most commonly, you will be under general anesthesia, which means you’ll be completely asleep during the operation, but in some cases, a less intense form of anesthesia might be used.
When in the operation room, you will be asked to lie flat on your back. The arm that will be operated on is placed on an arm table. A tourniquet, which is a device used to control bleeding, might be used. It’s placed as close to the shoulder as possible. The whole upper arm is then thoroughly cleaned and draped in a special sterile cover to keep the area clean during the surgery.
A traction device is attached to your arm to keep it steady during the operation – take note though, the pulling force applied should not be more than 10 lbs. to ensure safety.
For the surgeon to access your wrist, s/he may create portals (small entry points). These portals are made in two parts of your wrist. For the dorsal portals (the back of your hand), the surgeon will sit near your head. For the volar portals (the palm side of your wrist), the surgeon sits near your armpit. A small needle is inserted in these portals, ensuring it is inside your wrist joint. After ensuring this, a small amount of saltwater solution is injected to distend (expand) the joint which makes the surgery easier. Following this, a small cut is made and using a blunt instrument such as a hemostat, the surgeon carefully separates the tissues to avoid hurting any nerves or tendons. Then, a small cannula (small tube) is introduced for the arthroscope, which is a small camera that enables the surgeon to see inside your wrist.
Once the main portal is opened, the surgeon creates an inflow/outflow for the fluid to help maintain clear visualization of the internal structures. Other portals will also be opened following this procedure.
While doing these, care is taken always to avoid hurting nearby nerves and arteries. This is especially critical when making the 1-2 portal, which is located near vital structures like the superficial radial nerve and the radial artery.
The ulnar portal (near the side of your little finger) is created through a small incision made at the proximal wrist crease, or the fold of your skin where your hand meets your arm. Tendons are carefully moved aside, and a fine needle is inserted to ensure it’s placed correctly.
After all these preparations, the surgeon can then perform the planned surgical procedure, whether it’s for removing unhealthy tissue, repairing ligaments or treating the bones in your wrist.
Possible Complications of Wrist Arthroscopy
Wrist arthroscopy, which is a type of surgery that examines and sometimes repairs problems inside a wrist, very rarely leads to problems. But, it’s crucial for the doctor to have a good understanding of all the parts of the wrist to avoid accidentally damaging the nearby nerves, blood vessels, and tendon structures while making the surgical incisions. A group of researchers led by Ahsan decided to see just how often complications happened in wrist arthroscopy and found that they only occurred about 4.8% of the time.
Some of these complications were related to the position of the arm during surgery and the traction applied, which is a method used where force is applied to the arm. Other complications they found were injuries to the skin nerves, blood vessels, tendons that help to bend and straighten the wrist, ligaments, which are the tissues that connect bones, and the tissue at the end of the bones that helps to reduce friction, known as articular cartilage. Regardless, these potential complications are rare and doctors take many precautions to avoid them.
What Else Should I Know About Wrist Arthroscopy?
Wrist arthroscopy is a type of surgery that allows a doctor to see and operate inside your wrist without making a large cut. This makes the procedure less invasive, which means it’s generally safer, less painful and it makes recovery quicker. In addition, it has a low risk of complications or problems after the surgery. It’s much like having a super-powerful magnifying glass that gives doctors an incredible view into your wrist, allowing them to perform a variety of surgical procedures!