Whilst arthroscopy (key-hole surgery) of large joints such as the knee and shoulder is very common, arthroscopy of the wrist is a much more recent development, with indications and techniques continuing to evolve. From the 1980’s to 1990’s, wrist arthroscopy gained popularity primarily as a diagnostic tool and was soon acknowledged as the gold standard in diagnosis of a number of intra-articular wrist pathologies. With more recent advances in technology and the development of joint-specific and technique-specific instrumentation, the number of therapeutic arthroscopic wrist techniques described continues to expand.
Arthroscopy can provide a number of benefits over traditional open surgery for several conditions in and around the wrist. It is less invasive and the incidence of post-operative capsular contracture is reduced. Much like in larger joints, the amount of joint surface than can be examined is actually increased thanks to the small size of the instrumentation and angled nature of the scope, essentially allowing the surgeon to ‘look around corners’.
Whilst commonly performed under general anaesthesia, wrist arthroscopy can also be performed under a peripheral block, with newer techniques described using just local anaesthetic in a wide-awake patient to allow intra-operative dynamic assessment.
Some of the well-established techniques in wrist arthroscopy include:
• ganglion cyst excision
• removal of loose bodies
• assessment and treatment of ulnar sided pathology (TFCC)
• assessment and treatment of ligamentous injuries
• treatment of intra-articular fractures
Wrist arthroscopy is an exciting and dynamic technique that is continuing to evolve. Dr Alexander remains committed to remaining at the forefront of new and emerging arthroscopic techniques so that the benefits of these less invasive treatment options can be passed on to patients, optimising outcomes.