When surgery of the wrist is required, many procedures can be undertaken using a small telescope (arthroscope) and camera to look into the wrist joint and perform procedures.
At times arthroscopy can be used to make a diagnosis or to assess structures within the wrist to aid planning of further treatment. Wrist arthroscopy may also be used to undertake surgical treatment of conditions such as ligamentous injuries, some fractures, some cartilage and arthritis problems and excision of ganglions. The advantages of performing operations arthroscopically include smaller wounds, faster recovery times, and sometimes procedures can be undertaken arthroscopically that cannot be done by conventional open surgery.
In addition to diagnostic arthroscopy, interventional procedures include:
- Triangular fibrocartilagenous repair
- Distal ulnar wafer resection
- Scapholunate ligament repair
- Ulnocarpal ligament repair
- Debridement of degenerate tissue
- Assisted scaphoid fracture fixation
- Assisted distal radius fixation
- Radial styloidectomy
- Partial scaphoid replacement
- Partial or full trapeziectomy with or without interposition arthroplasty
The Arthroscopic Operation
An arm block or general anaesthetic is required. A tourniquet is placed on the arm, and the upper limb is put in a device (traction tower), to hold your wrist in the correct position. Some small incisions are used to place the telescope and small instruments into the different parts of the wrist joint, typically three to four in number. The wounds are sufficiently small enough to usually not require suturing.
The inside of the different parts of the wrist joint are visualised, and some conditions are treated, as discussed between Mr Jarrett and each patient before the procedure.
If required, other joints discussed preoperatively can also be assessed, such as the base of the thumb, distal radioulnar joint, pisotriquetral joint and some finger joints.
Risks of wrist arthroscopy include infection (under 1%), bleeding, stiffness, wound tenderness, tendon/nerve/blood vessel injury and no resolution of symptoms.
Arthroscopy Postoperative Care
Most arthroscopic procedures will require a small bandage postoperatively, which is reduced to a small dressing after two days, and then no dressings after a further week. Near to full recovery usually takes four weeks for diagnostic arthroscopy (simply looking around the wrist at arthroscopy). In procedures involving complex work within the joint, the postoperative treatment and splinting and recovery time will vary according to the nature of the operation, and Mr Jarrett will discuss this with you before the operation. Your wounds can be washed and moisturised from ten days postop.