Definition
The word arthroscopy comes from two greek words, ‘’arthro’’ (joint) and ‘’skopein’’ to look. Wrist arthroscopy is a minimally invasive technique used by orthopaedic surgeons to visualise the inside of the wrist joint. Other sites for arthroscopy include the knee, shoulder, hip and spine. Arthroscopy allows the surgeon to observe the anatomic parts of the wrist without making large incisions into muscle and tissues.Since the incisions for arthroscopy are smaller and disrupt less soft tissue than open surgery, recovery is often rapid and symptoms such as pain, stiffness and swelling are often minimised. Arthroscopy is mainly used for 2 reasons: to correct any problems within the joint and to make a more accurate diagnosis of the underlying problem.
Who is this operation for?
Wrist arthroscopy can be used to treat a number of conditions of the wrist. These include:
- Long term wrist pain: Arthroscopy can be done when the other investigations do not provide clear diagnosis. There may be areas of inflammation, damage surface and other findings after a wrist injury.
- Ganglion cyst: A mass or swelling that often develops around the wrist or back of the hand. The surgeon can remove the cyst arthroscopically and reduce the chance of cyst recurrence.
- Wrist fracture: Wrist arthroscopy can remove these broken fragments, align the broken fragments of bone, or stabilise them using pins, screws or wires.
- Carpal tunnel syndrome: Carpal tunnel syndrome is due to pressure on the nerve around the wrist, leading to numbness and tingling sensation in the hand. If this condition does not respond to non-surgical management, the surgeon can cut the ligament roof and relieve the pressure on the nerve via wrist arthroscopy.
- TFCC/Ligament tear: TFCC is a cushioning structure that supports the wrist. Any tears of the TFCC or ligaments around the wrist can be repaired arthroscopically.
What are the benefits of the operation?
The main benefit of wrist arthroscopy is to confirm what exactly the problem is and in many instances to treat the problem at the same time.
Risks of not having the surgery
The underlying wrist problem is not diagnosed and treated, thus leading to increasing pain, stiffness and reduced mobility of the wrist. This can significantly affects the simplest acts of daily life, such as gripping objects.
Complications
The risks and complications of a Wrist Arthroscopy include:
- Infection
- Bleeding
- Excessive swelling
- Nerve injuries
- Stiffness
- Scarring and tendon tearing
The stiffness can be treated with rehabilitation and therapy. An experienced surgeon, who specialises in wrist arthroscopy, can reduce the likelihood of complications.
Before the operation
Before your operation, you will be seen at the pre-admission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
-doctor
-nurse
-anaesthetist (if necessary)
Your doctor may do a medical review, mainly looking at your past medical conditions and your concerns. Your doctor will then perform an examination on your wrist and hand, at the same time doing certain tests to locate the pain. Imaging studies of the wrist may also be done which include, X-ray, CT or MRI.
Medications
Your doctor will advise you which medications you should stop or can continue taking before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Usually, arthroscopic surgery is performed under general anaesthesia or only the hand and arm are numbed (regional anaesthesia), where sedative is occasionally given to further relax the you.
About the Operation
2 or more small incisions (portal) about 5mm are made on the back of the wrist. A small camera is inserted through one of the small incisions which magnifies and projects the small structures in the wrist onto a television monitor, allowing for more accurate diagnosis.
Instruments can also be inserted via these incisions to help diagnose and manage various problems in the wrist. Fluid is usually infused into the joint to improve the visualisation during the procedure and distract the joint surfaces.
The procedure usually takes 45min – 1 hr. Occasionally, wrist arthroscopy is combined with open procedures.
After the Operation
After the surgery, the incisions are closed with stitches and a dressing is applied. A wrist splint can be used to allow full mobility of the fingers.
The duration for the cast or splint will vary depending on what was performed at the time of surgery. Elevation of the wrist is essential to prevent excessive pain and swelling from occurring.
Recovery and Rehabilitation
You can usually return to work or school in a few days or weeks depending on the wrist pathology that was found or treated. It also depends on what modifications your doctors advised. Your doctor may refer you for a physiotherapy course if necessary.
Here are few steps to help you care for your wrist after surgery:
- Wear your bandage or splint as directed by your doctor. Keep the dressing clean and dry.
- Shower as necessary. Cover your wrist with plastic to keep the dressing dry.
- Keep your hand raised above the level of your heart for first 2-3 days after surgery. This reduces swelling.
- Avoid gripping objects tightly or lifting with your affected arm
- Do the exercise taught to you in hospital
- If your job requires heavy lifting, you may not be able to return for several weeks
- Take pain medication as required (see Post-Operative Pain Relief)
- Keep in mind that full recovery can take up to 3-6 weeks
F.A.Q.s | Frequently Asked Questions
What are the alternative treatments to having a Wrist Arthroscopy?
Problems inside the wrist joint can be diagnosed using special imaging such as CT and MRI. However, you may need an arthroscopy to treat the problem.
Are there important things I need to tell my doctors?
- Fever and chills
- Fingers that are pale and blue
- Increased tenderness, swelling and redness of the incision
- Inability to move fingers or hands
- Any drainage from the incision
- Severe pain with or without activity