The technique known as wrist arthroscopy allows skilled surgeons to diagnose and treat many problems relating to the wrist through a series of small, minimally invasive incisions. The end result for patients is a faster recovery period with less pain, stiffness and swelling following surgery.
Over the course of the past several years the wrist has become the third most common joint to undergo arthroscopy, after the knee and shoulder, according to the American Society for Surgery of the Hand. So what exactly is wrist arthroscopy and how do you know when a patient is a good candidate for such a procedure?
What is Wrist Arthroscopy?
Wrist arthroscopy is an outpatient surgery procedure used to explore and identify the cause(s) of wrist pain and, in some cases, may be used to repair or remove damaged structures within the wrist. By utilizing small incisions (usually just a few millimeters in length), a camera and precise instrumentation, the procedure ensures the patient will experience the least amount of discomfort and disruption of soft tissue as possible.
“The wrist is made up of many bones and ligaments, making it a complex joint to perform surgery on,” says Michael D. Riggenbach, a hand and upper extremity surgeon at Orlando Orthopaedic Center. “An arthroscopy gives us the ability to see and access components of the wrist that, just a few years ago, required much more painful, invasive surgeries for the patient.”
To successfully perform a successful wrist arthroscopy, the surgeon must have a skilled operating room team, according to Dr. Riggenbach. “It also requires manual dexterity and 3-D spatial skills on the part of the surgeon to localize objects on a 2-D screen,” he says. “Equipment such as a 2.7mm scope, shaver, probes, are basic tools that are used to execute an arthroscopy.”
A small camera is placed on the end of a narrow fiber-optic tube which is then inserted through a small incision in the skin, similar to a knee or shoulder arthroscopy. The camera magnifies and projects the interior structures of the wrist.
Several small incisions are then made along the wrist so the surgeon can view the wrist from different angles and place various instruments into the wrist to help observe, diagnose and treat the area. Typically the surgery will last anywhere between twenty minute and two hours.
When is a Wrist Arthroscopy Performed?
Wrist arthroscopy is often performed following a patient-reported injury or they develop a feeling of pain, clicking or swelling – all of which may be indicative of an internal issue within the wrist.
“By providing a magnified view of all of the bones, joints and soft tissues found in the wrist, we’re able to use the technology as a diagnostic procedure for wrist pathology and as a minimally invasive alternative for fracture fixation, soft tissue debridement, repairs of torn cartilage and ligament reconstruction,” says Dr. Riggenbach. “It’s really one of the best ways we have currently to assess the ligaments, cartilage and bone found in the wrist.”
Dr. Riggenbach sees many wrist patients that have been referred from their primary care physicians after being diagnosed with persistent acute or chronic wrist pain. If the patient has failed the conservative measures of healing, such as splinting or NSAID’s, or if the patient is complaining of wrist instability or ulnar sided wrist pain, he says it may also be time to refer them to a hand and upper extremity specialist for further testing.
“Any patient is eligible for a wrist arthroscopy; however, it must be carefully considered in those patients with previous operations and major anatomic alterations,” he adds.
What Happens After Wrist Arthroscopy?
Following wrist arthroscopy patients are put in a protective bandage and, typically, a wrist splint will also be used to keep the wrist straight while still allowing full mobility of the fingers. Patients, as the case with most surgeries, will be given postoperative care instructions and told to elevate the arm to avoid excessive swelling and pain. At that point a follow up appointment may be scheduled, as well as any additional physical therapy, should there be a need.
Depending on what procedure was performed in conjunction with wrist arthroscopy, recovery time varies from several days with soft tissue debridement to several weeks or months if fracture fixation or soft tissue repair or reconstruction is performed,” says Dr. Riggenbach. “More than anything, patients need to understand that this is one of the best, least painful and most minimally invasive procedures available to us today to help them restore their wrists to its pre-injury state.”