Indications
Wrist arthroscopy has both diagnostic and therapeutic roles. Common indications include:
- TFCC injury
- scapholunate and lunotriquetral ligament injury
- unexplained mechanical wrist pain
- removal of loose bodies
- synovectomy
- assessment of chondral lesions
- assistance with reduction of selected distal radius or scaphoid fractures
Positioning
The patient is commonly supine with the elbow flexed and the hand placed in a traction tower. Traction distracts the radiocarpal and midcarpal joints.
Radiocarpal portals
Portal names reflect their relationship to the extensor compartments.
3-4 portal
- Between the third and fourth extensor compartments
- Just distal to Lister's tubercle
- Common primary viewing portal
4-5 portal
- Between EDC and EDM
- Common working portal
6R and 6U portals
- Immediately radial or ulnar to ECU
- Useful for TFCC visualisation and repair
- Dorsal sensory branch of the ulnar nerve is at risk
Midcarpal portals
- Midcarpal radial portal
- Midcarpal ulnar portal
These provide direct assessment of midcarpal articulations and intercarpal instability.
Complications
- dorsal sensory branch of ulnar nerve injury
- superficial radial sensory nerve injury
- extensor tendon injury
- chondral injury
- infection
- stiffness
References
- Orthobullets. Wrist Arthroscopy.