Arthroscopic Surgery for Hand and Wrist Pathology

Arthoscopy is a minimally invasive surgical technique developed over three decades ago in order to explore a joint from within. Tiny incisions are used to insert a fiberoptic instrument which serves as a camera to the inside of a joint and allows a surgeon to not only diagnose a problem but often times allows definitive treatment. This is opposed to the more standard technique of open joint surgery, which can result in increased scarring and prolonged recovery time.

More recently, general and gynecologic surgery have also benefited from these endoscopic techniques and joint arthroscopy has enjoyed great success in both the knee and shoulder. Smaller joints now have also benefited from this technique. A smaller arthroscope has been devised in order to diagnose and even treat wrist pathology, which up until now has been a problem area. We have even used arthroscopic techniques to treat pathology in the basal joint of the thumb and knuckle joint of the hand.
The wrist is widely regarded as the most complex joint in the human body. There are eight carpal bones, which articulate with the two forearm bones creating a joint that moves in multiple planes. Wrist pain until recently has often eluded doctors due to the complexity and small size of this joint. Even MRI technology still cannot elucidate subtle problems with this articulation. The carpal bones are held together by small ligaments, which are often the subject of trauma and can lead to instability of these bones, leading to posttraumatic arthritis in the future.

The triangular fibrocartilage is a small cartilage disc, similar to the meniscus in the knee, which often leads to wrist pain along the ulnar or pinky side of the wrist. Tears in these ligaments can now be diagnosed and either debrided or repaired using arthoscopic means. The artroscope can also be used to resect inflamed joint tissue (synovium), remove bony, loose bodies, or treat articular fractures. The tiny holes made by the arthroscope also provide a more cosmetic means to treat wrist ganglions or cysts that are not only a source of pain but are quite disfiguring in a thin person’s wrist. The traditional open excision of this cyst leads to an ugly scar in a very visible place. The arthroscopic technique avoids this. As in other joints arthroscopy has broadened the horizons in hand and wrist surgery leading to improved diagnosis and treatment of complex problems that were previously untreatable and difficult to diagnose.

Alejandro Badia, M.D, F.A.C.S.