Hand and Wrist

Wrist Arthroscopy

Anatomy

The wrist is a complex joint containing 8 small bones (carpals), the lower end of the forearm bones (distal radius and ulna), and many connecting ligaments.

Description

Arthroscopy is a minimally invasive surgical procedure used by orthopaedic surgeons to visualize, diagnose and treat problems inside the joint. Your doctor may recommend wrist arthroscopy if you have a painful condition that does not respond to nonsurgical treatments such as rest, physical therapy, and medications or injections to reduce inflammation. Wrist arthroscopy may be used to relieve painful symptoms resulting from damage due to injury or one of many orthopaedic conditions, such as: chronic (long-term) wrist pain, wrist fracturesWrist, Distal Radius FractureWrist, Scaphoid Fracture, ganglion cysts, carpal tunnel, ligament tears, and tears of the triangular fibrocartilage complex (TFCC).

Diagnosis

Following a complete physical examination of your hand and wrist, additional imaging studies may be needed, such as X-rays, magnetic resonance images (MRI), or arthrogram (X-ray taken after a contrast agent, or dye, is injected into the joint).

Preparation

Once the decision to have surgery is made, your orthopaedic surgeon may ask you to see your primary care physician to be sure you do not have any medical problems that need to be addressed before surgery. If you have certain health risks, a more extensive evaluation may be required. Be sure to inform your othopaedic surgeon of any medications or supplements you take, as these may need to be stopped prior to surgery.

If your general health is good, your arthroscopy is likely to be performed on an outpatient basis, which means you will not be required to stay overnight in the hospital. It is very important that you follow all instructions regarding when to stop eating or drinking prior to surgery, and when to arrive at the hospital.

Surgery

Before the operation, you will be evaluated by a member of the anesthesia team. Wrist arthroscopy is most commonly performed using regional nerve block anesthesia (only your hand and arm are numb). You may also be given a sedative to help you relax. The anesthesia team, with your input, will determine the best option for you. Your surgeon will see you before the surgery and sign your wrist to verify the surgical site. Although most arthroscopic procedures take less than an hour, the length of your surgery will depend on what your surgeon finds and what repairs are required.

Images from the arthroscope will be projected onto a monitor, allowing a thorough evaluation of the inside of the your joint. Once the problem has been diagnosed, specialized instruments such as probes, forceps, knives and shavers will be inserted and used to perform necessary treatment. After closing the incisions with a small stitch, a dressing will be applied. A splint may also be used.

You will remain in the recovery room for 1 or 2 hours after surgery. During that time, nurses will monitor your responsiveness and recovery from the anesthesia, and provide pain medication, if needed. When you are ready to be discharged, you will be given instructions covering medications, dressing care and other requirements. Be sure to have someone with you to drive you home.

Recovery

For the first 2 or 3 days after surgery, it is important to keep your wrist elevated, in a resting position that is higher than your heart. Your bandage should remain clean and dry. Ice may be used to help keep the swelling down. Although pain after surgery is usually mild, analgesic medications will help relieve any discomfort. Your surgeon may recommend special, gentle exercises to help maintain motion and rebuild your strength.

Complications

Complications from wrist arthroscopy are uncommon. However, as with any surgery, there are some risks. These may include infection, nerve injuries, excessive swelling, bleeding, scarring, or tendon tearing. An experienced surgeon, particularly one who specializes in arthroscopically treating the hand, can reduce the likelihood of complications.