Wrist Arthroscopy as a Diagnostic Tool in Chronic Wrist Pain

Abstract

Aims and Objectives: Our study aims to outline and investigate the role of wrist arthroscopy as both a diagnostic and a therapeutic tool in patients with chronic wrist pain. Materials and Methods: Between April 2014 and June 2015, 33 patients with chronic wrist pain undiagnosed with routine x-rays and with clinical suspicion of ligament injuries of the wrist underwent arthroscopic examinations. Both radiocarpal and midcarpal joint spaces were visualized using standard arthroscopic portals. The surgeries were carried out as day care procedures under general anesthesia. Therapeutic interventions as deemed necessary were done in the same sitting. The arthroscopic findings were further correlated with radiological and clinical findings. Results: In the 33 wrists that were arthroscopically examined, 17 lesions of the triangular fibrocartilage complex (TFCC) were found—10 (58.8%) were central perforations which were arthroscopically debrided whereas 7 (41.2%) were tears of the TFCC at its peripheral attachment and were repaired. The treated patients at a mean follow-up period of 7.1 months displayed an improvement in their Mayo wrist scores. A total of 13 scapholunate tears and 7 lunotriquetral tears were seen—which were graded arthroscopically. Partial tears (60%) were treated by thermal shrinkage and ablation while complete tears (40%) underwent open reconstruction. Cartilage defects of varying degrees were also noted in 6 patients. One patient was found to have extensive cartilage damage and was advised wrist fusion. No complications were noted in the follow-up period. Conclusions: Wrist arthroscopy is a potent diagnostic tool and tends to pick up lesions of intrinsic carpal ligaments and the TFCC which are often missed by advanced imaging techniques. It aids in staging of the lesions, thereby guiding their treatment, and provides a host of therapeutic offerings. It may be recommended in cases of chronic wrist pain where the clinical suspicion is strong and the operating team is well-versed with the technique.