Wrist Arthroscopy

Mr Mike Hayton
FRCS(Trauma and Orth) FFSEM (UK)
Consultant Orthopaedic Hand Surgeon

Other common names

 - Keyhole surgery
 - Wrist scope

Why is it done?

If your surgeon thinks you have a problem inside your wrist joint they may wish to look inside under direct vision with a camera. There are many reasons for us to wish to do this and include diagnosing ligament injuries, arthritis and cartilage damage/tears. There are an increasing number of treatments used with the arthroscope including trimming or repairing torn cartilage, removing loose bodies, removing inflamed lining of the joint and removing arthritic bone overgrowth.

Investigations

An MRI scan can also show problems inside the wrist joint and is occasionally used as an alternative investigation

Operative treatment

The surgery is a day case procedure usually by putting the arm to sleep so you can watch the television screen (if you wish!) or you may prefer to have a general anaesthetic. A simple look around takes about 15 minutes, but if other procedures need to be performed it can take longer. Approximately 3 or 4 small 3mm incisions are made on the back of the wrist to allow the camera and instruments inside. Care is taken not to injure the tendons and nerves just under the skin. After the arthroscopy the skin is sutured and a bulky dressing is applied.

There are two main areas in the wrist that we view.

The first video is the radiocarpal joint.

 The second is of the midcarpal joint.

 Post-operative rehabilitation

The patient is fit to go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. My preference is to remove the dressing at 2 days. The wound is cleaned and redressed with a simple dressing. The sutures are removed at about 10 days. Any further treatment that the arthroscopy has identified will be discussed at this visit.

Return to activities of daily living

It is my advice to keep the wound dry until the stitches are out at 10 days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick. It is probably advisable to delay returning to driving for at least 7 days or even when the stitches are removed.

Return to work:

Everyone has different work environments.
Please ask your surgeon for advice on this.

Complications

Overall, greater than 95% are happy with the result. However complications can occur.
There are complications specific to Wrist Arthroscopy and also general complications associated with hand surgery.

General complications:

 - Infection (Less than 1%)
 - Neuroma (Less than 1%, a coiled painful nerve bundle)
 - Numbness

Reflex Sympathetic Dystrophy - RSD (2% bad reaction to surgery with painful stiff hands - this can occur with any hand surgery from a minor procedure to a complex reconstruction.)

Specific complications:

Injury to tendons as the arthroscopy is introduced (less than 1%).