Arthroscopic Wrist Surgery
Wrist arthroscopy is both a diagnostic tool and minimally- invasive surgery for specific wrist and hand problems. Arthroscopy includes the use of a small camera (scope) and other small instruments that are inserted through small incisions. This allows the surgeon to look inside the small joints of the wrist to remove or repair damaged areas. In the wrist, this may be used to address conditions such as carpal tunnel syndrome, ganglion cysts and inflammatory (rheumatoid) arthritis as well as injuries to the cartilage and ligaments.
Wrist injuries are one of the leading joint-related problems in the United States. Wrist injuries are usually related to sports or recreational activities, work tasks, aging and skeletal conditions, and accidental falls. Certain sports that require high impact or weight bearing on the upper extremities such as football and gymnastics are more prone to these injuries.
Wrist arthroscopy is an outpatient procedure that can minimize the need for large complicated procedures and requires only small incisions with faster recovery times and provides earlier comfort to patients. Studies report that arthroscopy improves the success rate of surgery because there is less trauma to soft tissue.
Wrist Anatomy
There are eight small bones (carpal bones) in the wrist that are organized into two rows. Together they provide hand and wrist movement. Each carpal bone is joined to the next forming many small joints. Cartilage covers the ends of the bones at each joint. Ligaments attach bone to bone and in the wrist the ligaments attach the carpal bones to each other as well as to the forearm and hand bones.
The Triangular Fibrocartilage Complex, also called the TFCC, is a set of ligaments and cartilage tissue on the inside (ulnar) side part of the wrist. It stabilizes the forearm bones and forms a complex joint with the attached carpal bone to aide in grasping and forearm rotation. It is a common location for injury.
Triangular Fibrocartilage Complex Tears
TFCC tears may be caused from acute trauma to the wrist or degenerative conditions. Degenerative TFCC injuries consist of wear and tear and inflammatory disorders, and may result in disability and poor quality of life. Traumatic tears can occur when one falls on an outstretched hand. Tears cause pain at the base of the wrist on the small finger side, swelling at the wrist, clicking sounds, reduced range of motion and loss of grip strength.
Treatment of a TFCC tear is based on whether the wrist is stable, patient age, type of tear, and previous treatments at the time of presentation. Initially, when the wrist is stable, nonsurgical treatments include splinting or casting to immobilize the joint, activity modifications, oral medications and steroid injections.
Surgery may be indicated when the wrist is unstable or involves fractures, and when conservative treatments fail. Arthroscopic repair may include debridement which means removal or repair of damaged ligament, bone and cartilage. Debridement is often the treatment for degenerative type tears.
Whereas, repair of the TFCC ligaments may be more appropriate for traumatic type tears.
The majority of tears to the ligaments and cartilage of the wrist can be treated using wrist arthroscopy.
Carpal tunnel release
Carpal tunnel syndrome is pressure on a nerve in the carpal tunnel formed by the wrist bones. It feels like tingling and numbness in the hand, and even pain in the arm. Pressure can result from inflammation of the nerve or surrounding tissue. To relieve the symptoms pressure on the nerve must be reduced. This is accomplished with endoscopic carpal tunnel release, a special type of wrist arthroscopy during which the tissues are released while viewing with a camera.
Ganglion Cysts of the wrist and hand
Ganglion cysts are fluid filled cysts that are not cancerous and are usually harmless. However, when it interferes with function due to pressure, size or poor location as well as aesthetics, the cyst can be removed using wrist arthroscopy. The cause of ganglion cyst formation is not always known, but they are often associated with arthritis or repeated stress to the wrist.
Inflammatory arthritis
A majority of patients with inflammatory arthritis have hand and wrist problems, almost always affecting both wrists and hands. Wrist arthroscopy can be used to treat inflamed joint linings, perform joint fusions and enhance the placement of joint replacements.
At South County Orthopedic Specialists (SCOS) in Orange County, California, our hand specialists Dr. Lonnie J. Moskow and Dr. Amar A. Patel are hand and wrist fellowship- trained and proficient in arthroscopy surgical procedures. Patients suffering from wrist injuries can be assured that they will receive expert medical care at SCOS. Our state-of-the-art facilities and dedicated doctors and therapists are here to serve our community with offices in Irvine, Laguna Woods, and Fountain Valley California.
Hand & Wrist Specialists
Lonnie J. Moskow, MD
Dr. Moskow is fellowship- trained in hand and microvascular surgery at the Sydney Hospital Hand Center, a world-renowned center for hand surgery in Sydney, Australia. His practice covers all aspects of hand, wrist, and elbow surgery. Read Dr. Moskow’s biography.
Amar A. Patel, MD
Dr. Patel is fellowship- trained in hand and microvascular surgery at the prestigious Indiana Hand to Shoulder Center, the largest hand surgery training center in the world. His practice covers all aspects of hand, wrist, and elbow surgery. Read Dr. Patel’s biography.
