ARTHROSCOPY OF WRIST
Wrist arthroscopy has been rapidly evolving over the past 25 years from an experimental diagnostic instrument to a powerful tool for both accurate diagnosis and treatment of numerous ailments. Advances in camera technology, small instrument design, safe portal identification, and, most importantly, surgeon experience and comfort have all played a role in the development of this treatment modality.
Currently, wrist arthroscopy is considered the gold standard for evaluating and often treating chronic wrist pain. TFCC injuries are a common cause of chronic ulnar-sided wrist pain. Wrist arthroscopy allows accurate identification of these injuries, determination of central versus peripheral injury, and treatment. Central TFCC tears cause painful clicking and catching in the wrist and can be debrided arthroscopically back to a stable rim of tissue. Peripheral detachment of the TFCC from the distal ulna causes ulnar-sided wrist pain with potential instability of the DRUJ and can be successfully treated with the arthroscopic passage of sutures and secure repair with gratifying results. Radiocarpal and midcarpal synovectomy, ganglion excision, scapholunate and lunotriquetral tear debridement versus repair, and loose body removal can also all be successfully treated arthroscopically. Arthroscopic visualization of both distal radius and scaphoid fracture fixation has also been reported as an adjunct to standard treatment, allowing direct visualization of intra-articular reduction and fixation.
Wrist arthroscopy requires a thorough understanding of wrist anatomy to allow safe passage of instrumentation and recognition of the anatomy and pathologic processes encountered. Arthroscopic portals are identified by their relationship to the numbered extensor tendon compartments along the dorsum of the wrist. The standard viewing portal is the 3-4 portal, with supplemental portals for instrumentation often occurring at the 4-5 interval or on either side of the extensor carpi ulnaris tendon (6R and 6U). Midcarpal arthroscopy is a critical component to any diagnostic wrist arthroscopy. The midcarpal viewing and working portals allow accurate evaluation and grading of both scapholunate and lunotriquetral instability. More advanced arthroscopists have utilized both palmar portals and DRUJ portals for nhanced viewing of complex intra-articular ailments.