Dorsal capsule tears of the wrist

Abstract

Introduction Large dorsal capsule tears of the wrist are misdiagnosed because this lesion is unknown. Wrist arthroscopy allowed the diagnosis and the treatment. This study reports the results of the procedure. Materials and methods This retrospective study reported the patients with dorsal capsule tears between October 2011 and September 2014. The procedure was performed on outpatient under local regional anesthesia. The diagnosis is done arthroscopically. We always found a large rupture of the dorsal capsule with direct vision of the extensor tendons from the radiocarpal joint. The reparation is performed by a dorsal capsuloligamentous repair after enlarging the 3–4 portal. Results Sixteen procedures were performed on 15 patients, which represent 2% of the wrist arthroscopy. One was excluded because the follow-up was done abroad. There were 7 men and 7 women, mean age 27,9 years old (14–43). The surgery was performed on average 21 months after the accident (2–96). The clinical examination was not specific, neither the imaging. The diagnosis was performed arthroscopically. The scapholunate ligament was intact from the radiocarpal joint in 46,6%. In the midcarpal joint, we reported 4 stage 1 with EWAS classification, 2 stage 2B, 1 stage 3A, 4 stage 3B, 1 stage 3 C and 1 stage 4. A peripheral lesion of the TFCC was reported in 6 cases. A splint was worn on average 47.8 days. The average follow-up was 7.75 months (1.5–32.5). The range of motion and strength improved in all cases. The pain decreased from 6.3 u (4–8) to 0.9 (0–2) and the dash from 44.5 (20,45–95,45) to 6.25 (0–27,27). All radiographs were normal at the longest follow-up. We reported two Sudeck syndromes. Discussion Diagnosis of chronic wrist pain is difficult. More often, they are due to posttraumatic lesions - fracture or ligamentous tears, which lead both to arthrosis. A large dorsal capsule tear is one of the etiology, and its diagnosis was made possible thanks to arthroscopy, others paraclinic exams being poor. Conclusion Large dorsal capsule rupture could explain some non-diagnosed wrist pain. The diagnosis is arthroscopic. Arthroscopic suture avoids stiffness related to open surgery. These encouraging preliminary results require a larger serie with longer follow-up.