Techniques of Wrist Arthroscopy* **

Abstract

Arthroscopy has revolutionized the practice of orthopaedics by providing the technical capability to examine and treat intra-articular abnormalities directly. The development of wrist arthroscopy was a natural evolutionary progression from the successful application of arthroscopy to other, larger joints. Wrist arthroscopy has seen considerable growth since Whipple et al. reported their original description of the techniques that they developed for viewing the anatomy of the wrist56. The wrist is a labyrinth of eight carpal bones, multiple articular surfaces with intrinsic and extrinsic ligaments, and a triangular fibrocartilage complex, all within a five-centimeter interval. This perplexing joint continues to challenge clinicians with an array of potential diagnoses and treatments. Wrist arthroscopy allows direct visualization of cartilage surfaces, synovial tissue, and ligaments under bright illumination and magnification. While most acute sprains of the wrist with normal radiographic findings resolve after temporary immobilization, how to further evaluate the patient who does not have improvement after such treatment is controversial. Tricompartmental wrist arthrography has historically been the so-called gold standard for the detection of intra-articular abnormalities9,10,43,54. However, the proved ability of wrist arthroscopy to enable detection and simultaneous treatment of wrist injuries, as well as the introduction of magnetic resonance imaging, has markedly altered this situation28,38,44. Adolfsson used arthroscopy to examine 144 patients who had posttraumatic wrist pain and normal findings on standard radiographs1. Ligamentous changes were observed in seventy-five patients; lesions of the triangular fibrocartilage complex, including lunotriquetral instability, in sixty-one patients; and varying degrees of scapholunate instability, in fourteen patients. The indications for wrist arthroscopy continue to expand as new techniques and instrumentation are developed. Diagnostic indications include assessment of tears of the interosseous ligaments and determination of whether they are partial or complete …