Underwent Wrist Arthroscopy Research Articles

Correlation between dorsal capsulo-scapholunate septum (DCSS) lesion and predynamic scapholunate instability

ObjectiveScapholunate instability is the most common ligament injury of the wrist. In case of predynamic instability, diagnosis can be difficult, even under arthroscopy. Scapholunate instability is not the result of an isolated injury to the scapholunate interosseous ligament. Scapholunate stability is dependent not only on the scapholunate ligament, but on a complex that is comprising intrinsic and extrinsic ligaments. The dorsal capsule-scapholunate septum (DCSS) is one of the secondary stabilizers of the scapholunate complex. The objective of the present study was to investigate the correlation between DCSS lesion and predynamic scapholunate instability. MethodA prospective multicenter study included patients who underwent wrist arthroscopy for traumatic wrist. Arthroscopic DCSS lesion stage and instability according to European Wrist Arthroscopy Society stage were assessed. ResultsTwenty-seven subjects were included. We found a significant correlation between pathological DCSS and predynamic scapholunate instability and a correlation between DCSS lesion severity and instability level. ConclusionIsolated DCSS lesion should be considered a predictive factor for predynamic instability.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

3T MRI of wrist ligaments and TFCC using true plane oblique 3D T2 Dual Echo Steady State (DESS) - a study of diagnostic accuracy.

This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3D T2 Dual Echo Steady State (DESS), in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold-standard. In a retrospective cohort review, patients who underwent wrist arthroscopy and MRI over 2 years (n=46) were identified. Dedicated axial and coronal reformats were obtained from 3D T2 DESS sequence for assessing intrinsic ligaments and triangular fibrocartilage (TFCC). At arthroscopy, tears were classified using Geissler's classification and compared to MRI findings. The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87%, specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. TFCC tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. 3T wrist MRI with dedicated reformats from 3D T2 DESS has a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3D T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of 95% can lead to reduced need for diagnostic arthroscopy of the wrist. This study assesses the diagnostic performance of unenhanced 3T MRI with 3D T2 DESS in assessing traumatic wrist ligament tears. The accuracy of T2 DESS in wrist imaging has not been previously reported.

Return-to-Sport Time and Postoperative Performance in MLB Players Undergoing Wrist Arthroscopy.

Wrist injuries are common in sports and can result in prolonged time missed from playing. This study aimed to determine in Major League Baseball-players after arthroscopic wrist surgery the return-to-sport (RTS) rate, postoperative career length, and changes in performance compared with preoperative statistics and matched controls. Major League Baseball players who underwent arthroscopic wrist surgery from 1990 to 2019 were identified. Demographic and performance data were collected for each player, and matched controls were identified. Comparisons were made via paired samples Student t tests. Twenty-six players (27 surgeries) were identified. The average age of included players was 28.9 ± 2.9 years with an average professional experience of 5.2 ± 3.4 years. Eighty-four percent of players returned to sport, with an average RTS time of 5.0 ± 2.7 months. A statistically significant (P < .05) decrease was seen in preoperative and postoperative runs scored per season (95.6 ± 91.3 vs 41.0 ± 29.5), batting average (BA) (0.270 ± 0.024 vs 0.240 ± 0.036), and average wins above replacement (WAR) (1.5 ± 1.1 vs 0.8 ± 0.9). Major League Baseball players who underwent arthroscopic wrist surgery had an RTS rate of 84% at a mean time of 5.0 months. There was no significant difference in performance statistics between cases postoperatively and matched controls overall, with some differences in performance found when categorized by position. However, a significant decrease in performance among case players was observed between preoperative and postoperative performance, including runs per season, BA, and WAR.

Fibrocytes in early and long-standing rheumatoid arthritis: a 6-month trial with repeated synovial biopsy, imaging and lung function test

ObjectivesTo correlate the level of fibrocytes in peripheral blood, synovial tissue and in vitro culture in rheumatoid arthritis (RA) with changes in disease activity, imaging and pulmonary function.MethodsTwenty patients with...

The Diagnostic Value of the Ulnocarpal Stress Test for Differentiating the Symptomatic Triangular Fibrocartilage Complex Tear from the Incidental Tear

Purpose: The purpose of this study was to determine the diagnostic value of the ulnocarpal stress test (UCST) for differentiating the symptomatic triangular fibrocartilage complex (TFCC) tear from the incidental tear.Methods: From January 2013 to May 2020, a study was performed on 109 patients who underwent wrist arthroscopy and showed TFCC tear. Patients who had ulnar-sided wrist pain along with TFCC tear, and showed postoperative symptom improvement, and those with other lesions excluded were defined as symptomatic tear (experimental group) and the rest were defined as asymptomatic tear (control group). Diagnostic values of the UCST for differentiating the symptomatic TFCC tear from the incidental tear were calculated.Results: The UCST showed a sensitivity of 54%, a specificity of 95%, a positive predictive value of 98%, a negative predictive value of 31%, a positive likelihood ratio of 10.34, a negative likelihood ratio of 0.48, and an overall diagnostic accuracy of 61%. Conclusion: The UCST showed limited diagnostic value for symptomatic TFCC tear. Therefore, this test needs to be regarded as a part of diagnostic process and their results should be interpreted in the context of other relevant clinical information before reaching the diagnosis of symptomatic TFCC tear.

Prevalence of Ganglion Cyst Formation After Wrist Arthroscopy: A Retrospective Longitudinal Analysis of 2420 Patients.

Dorsal wrist ganglion cysts arise from the leakage of synovial fluid through tears in the scapholunate ligament and/or dorsal wrist capsule. An analogous disruption of the dorsal capsule is created with routine portal placement during wrist arthroscopy. We hypothesized that wrist arthroscopy would predispose to wrist ganglions. Using the Truven MarketScan Outpatient Services Database from 2015 to 2016, patients who underwent wrist arthroscopy and developed an ipsilateral wrist ganglion were identified. Exclusion criteria included ganglion diagnosis preceding arthroscopy and bilateral pathology. Postoperative ganglion diagnosis was modeled with logistic regression. Predictor variables included age, gender, comorbidities, and arthroscopic procedure. In all, 2420 patients underwent wrist arthroscopy. Thirty (1.24%) were diagnosed with an ipsilateral wrist ganglion at a mean time of 4.0 months (standard deviation: 2.4, range: 0.2-9.0). Significant predictors of ganglion diagnosis included female gender (odds ratio [OR]: 4.0, P < .01) and triangular fibrocartilage complex and/or joint debridement (OR: 0.13, P < .01). By comparison, among all 24,718,751 outpatients who had not undergone wrist arthroscopy, 39,832 patients had a diagnosis of a wrist ganglion cyst (0.16%). Wrist arthroscopy is associated with a postoperative rate of ganglion cyst formation that is nearly 8 times the rate in the general population. Additional studies are needed to investigate techniques that minimize the risk of this complication.

Clinical and Epidemiological Features Among Patients with Wrist Arthroscopy Surgery: A Hospital-based Study in China.

ProposeTo analyze the clinical and epidemiological features of patients who underwent wrist arthroscopy procedures.MethodsThis is a cross‐sectional epidemiological study. The study included a cohort of patients who underwent wrist arthroscopy procedures in a national orthopaedic referral center from 1 February, 2014 to 1 February, 2019. The medical records, diagnosis, and every wrist arthroscopy procedure of all the patients were collected and reviewed. The epidemiological features, detail of the diagnoses, and the procedures of all the patients were systemically analyzed. All the patients were divided into two groups: trauma and non‐trauma conditions. The complexity of the wrist arthroscopy procedure was classified into simple procedures (exploration or debridement) and complex procedures (repair or reconstruction). χ2 test was used to compare proportions between the procedures of different complexity and the two groups of patients.ResultsA total of 533 patients (332 males and 201 females) were included in this study. More than half (56%) of the patients were in the age group 21–40 and nearly two thirds (62%) of all the 533 patients were male. The diagnoses of all the patients could be classified into eight categories: (i) TFCC injury; (ii) ulnar impactions syndrome; (iii) carpal trauma (carpal bone fractures and/or carpal ligament injures); (iv) distal radius fractures; (v) carpal bone cyst or necrosis; (vi) ganglion cyst; (vii) wrist arthritis; and (viii) disorders of small joint of the hand. The most common conditions treated with wrist arthroscopy were TFCC injury (172 cases), followed by carpal trauma (125 cases) and ulnar impaction syndrome (84 cases). The simple arthroscopic procedures (exploration or debridement) account for 53% of all the procedures while complex reparative or reconstructive procedures account for 47%. There was a significant difference in the proportion between simple procedures and complex procedures in both trauma and non‐traumatic patients. Repair or reconstruction procedures were more frequently performed for wrist trauma patients, whereas exploration or debridement procedures were more frequently performed for non‐trauma patients.ConclusionsThe largest group of patients who underwent wrist arthroscopy surgery are those who complained of ulnar‐sided wrist pain and the commonly conducted wrist arthroscopy procedures have evolved from simple exploration/debridement to the more complex repair or reconstruction procedures in China.

Efficacy of Perineural versus Systemic Dexamethasone to prolong analgesia after Supraclavicular Nerve Block in patients undergoing Wrist Arthroscopy

Abstract Background Poorly controlled acute pain after surgery is associated with a varity of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Wrist arthroscopy is a very common surgery and performed as a day case surgery and need good postoperative analgesia. Many adjuvant drugs are added to bupivacaine to prolong the duration of sensory block like opioids and dexamethasone. Objective The aim of this thesis was to study the effect of adding both perineural &amp; systemic dexamethasone as an adjuvant to bupivacaine in supraclavicualr nerve block. The comparison included the the effect on hemodynamics, postoperative pain &amp; postoperative analgesic requirement. Methods In our study, 40 patients were randomly divided into two equal groups: Group #1 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml Dexamethasone ‘8 mg’) &amp; 2 ml normal saline was injected IV. Group #2 (20 patients): Block with 18 ml Bupivacaine 0.5% (+ 2 ml normal saline) &amp; 2 ml Dexamethasone ‘8 mg’ was injected IV. Results Our study showed that addition of 8 mg dexamethasone to bupivacaine in supraclavicular nerve block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects however, slight better outcome for the perineural route. Conclusion Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post operative analgesia with negligible side effects with slightly better outcome to the perineural route.

Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy.

Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing wrist arthroscopy for nontraumatic wrist pain. Patients who underwent a wrist arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). Significant gender differences exist in the preoperative care for patients undergoing wrist arthroscopy. Men use more imaging, implying more intense preoperative investigation for wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.

Application of wrist arthroscopy in treating scaphoid nonunion advanced collapse

Objective To investigate the clinical effect of wrist arthroscopy in the treatment of scaphoid nonunion advanced collapse (SNAC). Methods A retrospective case series study was performed on the clinical data of 15 SNAC patients admitted from March 2011 to January 2016. There were 12 males and three females, with a mean age of 32 years (range, 26-43 years). There were nine cases of right wrist injury and six cases of left wrist injury. The injury duration was 14-72 months, with an average of 18 months. According to the evaluation of the extent of wrist joint inflammation involvement under wrist arthroscopy, there were nine cases at SNAC I stage, four at stage II, and two at stage III. Stage I patients underwent wrist arthroscopy assisted radius styloid process resection, scaphoid sclerosis bone removal, and iliac bone grafting and internal fixation. Stage II and III patients underwent wrist arthroscopy assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone. Joint healing time in the first month of fracture and fusion, visual analogue score (VAS) before operation and at the last follow up, joint mobility, and grip strength were recorded. Wrist function was evaluated by modified Mayo wrist function score at the last follow up. Results The patients were followed up for 9-23 months, with an average of 14 months. All cases were seen primary bone healing. The mean time of fracture healing was 11.7 weeks in stage I SNAC patients and the mean healing time was 11 weeks in stage II and III patients in the first month of joint fusion. VAS decreased from (5.9±0.8)points to (1.6±0.9)points. Range of motion of the wrist including the flexion/extension arc and the radial/ulnar deviation arc increased respectively from preoperative (38.7±6.3)°, (28.6±11.2)°, (19.8±1.4)° and (22.7±5.7)° to postoperative (54.1±5.8)°, (43.3±9.3)°, (22.0±1.9)° and (30.3±4.3)°. Grip strength was improved from preoperative (10.7±2.4)kg to postoperative (15.0±1.9)kg (all P<0.05). The modified Mayo wrist score was increased from preoperative (57.9±7.3)points to postoperative (84.5±6.9)points (P<0.05). According to modified Mayo wrist scores, the result was excellent in one case, good in nine cases and fair in five. Conclusions For patients with SNAC, it is necessary to evaluate the staging under wrist arthroscopy. Arthroscopy assisted scaphoid bone grafting can be applied to stage I patients. For stage II and III patients, wrist arthroscopy-assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone is helpful to facilitate bone healing, relieve pain, and improve function. Key words: Scaphoid bone; Fractures, ununited; Arthroscopy; Bone transplantation

Wrist Arthroscopy in Children and Adolescent With Chronic Wrist Pain: Arthroscopic Findings Compared With MRI.

Wrist arthroscopy is a dynamic diagnostic procedure and its indications are growing as a treatment modality in the adult population. The aim of the study was to retrospectively report our series of pediatric and adolescence with chronic wrist pain, with or without wrist instability who underwent wrist arthroscopy after failing at least 4 months of conservative management. Our secondary aim was to report the sensitivity and specificity of clinical examination and magnetic resonance imaging evaluation for various injury subgroups against the gold standard of the arthroscopic findings. Technical challenges, complications, and outcomes are also discussed. A retrospective review of the medical records of 32 pediatric and adolescent patients who underwent wrist arthroscopy was conducted. Preoperative clinical diagnosis, radiographic, and intraoperative findings including classifications of triangular fibrocartilage complex (TFCC) and interosseous ligaments were obtained. Patients were followed up to 1 year postoperatively and were discharged if symptom free. Thirty-three wrist arthroscopies in 32 patients were performed from 1996 to 2004. There were 2 male and 30 female patients. At arthroscopy 16 wrists were found to have TFCC injuries, 11 wrists had scapholunate injuries, and 8 had lunotriquetral (LT) injuries. Clinical examination for diagnosis of TFCC injury was too sensitive and nonspecific; however, clinical diagnosis of scapholunate injury was sensitive and specific. LT injury was under diagnosed clinically. Magnetic resonance imaging was found to have a low sensitivity for diagnosis of LT injury but diagnosis of TFCC was sensitive and specific. The sex ratio of 2 males:30 females was startling. Nevertheless, this therapeutic level 3 study supports a thorough search for pathology in any patient with persistent wrist symptoms because pathology was identified in 32 of the 33 wrists at arthroscopy. Level III-Therapeutic.

Microfracture for Ulnar Impaction Syndrome: Surgical Technique and Outcomes with Minimum 2-Year Follow-up.

Purpose The purpose of this study is to assess functional and patient-reported outcomes after lunate microfracture for management of lunate chondral lesions in the setting of ulnar impaction syndrome. Methods This was a retrospective review of all patients undergoing wrist arthroscopy for triangular fibrocartilage complex pathology by one surgeon from 2007 until 2010. Disabilities of the arm, shoulder, and hand (DASH) scores were assessed preoperatively and at minimum 2-year follow-up. Patient-rated wrist evaluation and bilateral wrist range of motion, grip strength, and key pinch strength were assessed at final follow-up. Results A total of 22 patients underwent microfracture of the carpus during the study period, of which 7 met all inclusion and exclusion criteria. Mean DASH scores improved significantly (p < 0.001), from 58.3 (standard deviation: 13.5) before the procedure to 15.1 (standard deviation: 8.6) at minimum 2-year follow-up. Operative wrist pronation and supination showed equivalence with the contralateral wrist at final follow-up (p < 0.05, E = 15 degrees, standard deviation pronation: 3.25, supination: 3.49). Discussion This study suggests that lunate microfracture may be a useful technique for treating articular defects of the lunate in the setting of ulnar impaction syndrome. Type of Study/Level of Evidence Therapeutic, level IV.

Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture.

The purpose of this study was to assess characteristics of radiocarpal arthrofibrosis after intra-articular distal radius fractures (DRF). In this study 20 patients who underwent wrist arthroscopy at the time of implant removal after volar plating for intra-articular DRF were included retrospectively. The direction of fibrous tissue formation (FTF) and its rigidity were investigated. The findings were correlated to the course of intraarticular fracture lines seen in the preoperative CT, patient age and AO fracture types. In all patients FTF spanned the radiocarpal joint. Fibrous tissue formations extended from previous fracture gaps to the scapholunate interosseous ligament and/or capsule. Four basic types of FTF (Type 1-4) and two combination types (Type 1a, 2a) were found. Fibrotic fans with dorsal capsular attachment (Type 1, 30%) and its combination with dorsal capsule obliteration (Type 1a, 40%) were the most common findings. Mild rigidity was present in 3 (15%), moderate in 7 (35%), and severe rigidity in 10 cases (50%). Fracture lines crossing the radius extensor compartments or interfacet ridge, cartilage defects and C3 fractures showed the highest risk to develop severely rigid fibrous tissue formations. In older patients and in more comminuted fractures the number of rigid fibrous tissue formations was higher. Fracture severity correlates with the development of rigid intra-articular FTF. In case of rigid FTF with restricted wrist motion arthroscopic debridement may be considered at the time of hardware removal.

Auswirkungen einer intraartikulären Substitutionstherapie mit Hyaluronsäure im Rahmen handgelenksarthroskopischer Operationen. Eine randomisierte, kontrollierte, prospektive, unverblindete, monozentrische Vergleichsstudie

The present study investigates the effect of an intra- and postoperative intraarticular hyaluronan injection (HS) in patients undergoing wrist arthroscopy. A total of 140 adults were included and prospectively randomised to one of 2 treatment groups. All patients presented wrist pain resistant to non-operative therapy. 69 patients were assigned to therapeutic wrist arthroscopy without additional treatment (A-group), another 70 patients were assigned to wrist arthroscopy and additional intraarticular instillation of a 1% HS solution (HS-group). The HS administration (2 mL of 1% HS solution each) was performed directly at the end of arthroscopic procedure and a second time 3 weeks after surgery. For outcome assessment, Mayo wrist score (modified according to Krimmer, MMWS), DASH questionnaire, absolute grip strength, VAS pain (visual analogue scale) and clinical global impression (CGI) of patients and investigators were used. The follow-up was 6 months. Furthermore, the correlation between severity of pathological findings and level of postoperative benefit was investigated. In both groups, pain decreased and the function of the wrist joint improved. While pa-tients with additional HS injection had significantly better values in MMWS than patients without additional HS injection, no significant differences could be observed for DASH score, absolute grip strength and pain intensity. 12 and 24 weeks after surgery, therapeutic success was rated better in HS-group than in A-group. The highest clinical benefit was obtained for patients in the HS-group with marginal to moderate pathological findings. The benefit of therapeutic wrist arthroscopy can be significantly improved by a 2-time intraarticular substitution of hyaluronan.

Arthroscopic Treatment of Dorsal Wrist Syndrome (DWS) (SS-51)

Arthroscopic Treatment of Dorsal Wrist Syndrome (DWS) (SS-51)

Joint Space Height Correlates with Arthroscopic Grading of Wrist Arthritis

Osteoarthritis of the radiocarpal joints is commonly encountered by hand surgeons. To date, there is no well-defined method of radiographically grading osteoarthritis of the wrist. Preoperative radiographs of 48 patients undergoing wrist arthroscopy were evaluated retrospectively. Images were graded subjectively by five surgeons based on overall severity of arthritis, osteophytes, subchondral cysts, and subchondral sclerosis. The joint space height (JSH) ratio was calculated by measuring the space of the mid-radioscaphoid and mid-radiolunate joints and dividing each by the height of the capitate. Arthroscopic grading of arthritis was obtained from operative records and compared to subjective and objective grades. ANOVA testing evaluated for statistical significance with p < 0.05. Inter-rater and intra-rater reliability was determined using Pearson's correlation analysis and Cohen's kappa coefficient. Objective measurement using the JSH ratio demonstrated a significant decrease as arthroscopic arthritis grade increased for both radioscaphoid and radiolunate joints. Subjective grading of radioscaphoid and radiolunate joints was able to detect moderate/severe, but not mild arthritis. Subjective grading underestimated the degree of arthritis, particularly in the radiolunate joint. Inter-rater reliability was better for objective compared to subjective grading. Subjective grading of wrist arthritis can detect moderate/severe radiocarpal arthritis but poorly evaluates early arthritis and underestimates severity. Objective grading using the JSH ratio accurately grades radioscaphoid arthritis and detects early radiolunate arthritis. The JSH ratio more accurately assesses radiocarpal arthritis compared with subjective grading. As there currently is no accepted method to radiographically grade wrist arthritis, the JSH ratio represents a promising option.

Évaluation clinique rétrospective des traitements arthroscopiques des lésions du complexe triangulaire du poignet

ObjectivesThe aim of this study is the retrospective clinical evaluation of the arthroscopic treatments for triangular fibrocartilage complex tears. MethodsBetween 2003 and 2010, 76 patients with a traumatic lesion (Palmer type 1) and 25 patients with a degenerative lesion (Palmer type 2) of the triangular fibrocartilage complex underwent wrist arthroscopy. Clinical evaluations were based on the Mayo Modified Wrist Score (MMWS), on a compared measurement of the grip force and on a measurement of the different ranges of motion. We also made a subjective evaluation of the benefit brought by arthroscopy and a retrospective evaluation of the pre and postoperative pain. ResultsMean MMWS was 86.3 for traumatic lesions and 83 for degenerative lesions. Mean grip force was 84.8 (Palmer type 1) and 84.2 (Palmer type 2) compared to the controlateral side. Mean ranges of flexion-extension, prosupination and radioulnar motions were 135°, 164° and 56° respectively for traumatic lesions and 130°, 156° and 54° respectively for degenerative lesions. Ninety-four percent of the operated patients reported an improvement of the symptomatology with better results for type 1 (98.7%) compared to type 2 (80%). We noted a clear diminution of the postoperative pain compared to the preoperative's one with frequently some mild persistent pain however. ConclusionsArthroscopic treatments of the triangular fibrocartilage complex seem to be effective with an improvement of the symptomatology.

Wrist arthroscopy in children and adolescents: a single surgeon experience of thirty-four cases

The purpose of this study was to report our experience of wrist arthroscopy in children and adolescents with chronic wrist pain in a retrospective single surgeon series. Therefore, technical differences or obstacles compared to standard wrist arthroscopy in adults, and complications were highlighted. A retrospective data review of all patients undergoing wrist arthroscopy between 2002 and 2011 was performed. The basic inclusion criteria was chronic, therapy refractory wrist pain for more than three months in children and adolescents aged 18 years and younger. In total, 34 arthroscopies in 27 girls and six boys were reviewed. The mean age at time of arthroscopic exploration was 14.6 years (range, 9.8-17.9 years). A total of 28 wrists showed a triangular fibrocartilage complex (TFCC) tear (82.4%). In 26 of 34 (76.5%) inspected wrist joints additional pathologies besides TFCC tears were documented. As a consequence, 14 arthroscopic TFCC resections, two arthroscopic TFCC repairs and seven open resection arthroplasties were performed. Other concomitant procedures (e.g., ulna shortening) were performed in 25 patients (26 wrists) because of predisposing malformations. No intraoperative or postoperative complications related to the arthroscopies were observed. No relevant technical differences to wrist arthroscopy in adults were experienced apart from cases of major anatomical malformations. Wrist arthroscopy has been shown to be a safe procedure to detect and treat paediatric wrist disorders. Nevertheless, we believe that this procedure should only be carried out by well-trained, experienced hand surgeons.

Analgesia After Wrist Arthroscopy: A Randomized Control Trial (SS-46)

Introduction Wrist block has been used to provide pain relief for many procedures on the hand and wrist but its role in arthroscopy remains unexplored. We aimed to evaluate and compare the analgesic effect of portal and wrist joint infiltration to the pain relief provided by a wrist block (WB) after wrist arthroscopy. Methods Ethical approval was obtained from the local research ethics committee. A prospective, randomized, double-blind clinical trial was designed and patients undergoing wrist arthroscopy as day cases were recruited for the study. 10 milliliters of 0.5% levo-bupivacaine (Chirocaine) was used for infiltration of the portals and the wrist joint after the procedure or 15 milliliters for the WB before the procedure. The effects were evaluated using the 10 points Visual Analog Score (VAS) score. The primary outcomes for statistical analyses were pain scores, average pain score, area under the curve pain scores, and duration of effect. Results We provide demographic data for patients undergoing these procedures in our unit, outcomes of both techniques of analgesia and finally compare the VAS scores and duration of the analgesia. There were no statistically significant differences between the two groups with respect to age, weight, gender, and duration of surgery. The results should allow us to standardize the technique for pain relief in these patients and allow patients to make an informed choice. Conclusion Wrist arthroscopy is the gold standard in diagnosis and treatment of carpal ligament injuries and its role is continuously being expanded. Concerns have been raised in animal and human in vitro studies with regards to chondrotoxicity of the local anesthetic agents on joint infiltration. We believe both techniques provide satisfactory pain relief but WB does not expose the patients to the potential risk of chondrotoxicity and hence should be used instead of joint infiltration. Wrist block has been used to provide pain relief for many procedures on the hand and wrist but its role in arthroscopy remains unexplored. We aimed to evaluate and compare the analgesic effect of portal and wrist joint infiltration to the pain relief provided by a wrist block (WB) after wrist arthroscopy. Ethical approval was obtained from the local research ethics committee. A prospective, randomized, double-blind clinical trial was designed and patients undergoing wrist arthroscopy as day cases were recruited for the study. 10 milliliters of 0.5% levo-bupivacaine (Chirocaine) was used for infiltration of the portals and the wrist joint after the procedure or 15 milliliters for the WB before the procedure. The effects were evaluated using the 10 points Visual Analog Score (VAS) score. The primary outcomes for statistical analyses were pain scores, average pain score, area under the curve pain scores, and duration of effect. We provide demographic data for patients undergoing these procedures in our unit, outcomes of both techniques of analgesia and finally compare the VAS scores and duration of the analgesia. There were no statistically significant differences between the two groups with respect to age, weight, gender, and duration of surgery. The results should allow us to standardize the technique for pain relief in these patients and allow patients to make an informed choice. Wrist arthroscopy is the gold standard in diagnosis and treatment of carpal ligament injuries and its role is continuously being expanded. Concerns have been raised in animal and human in vitro studies with regards to chondrotoxicity of the local anesthetic agents on joint infiltration. We believe both techniques provide satisfactory pain relief but WB does not expose the patients to the potential risk of chondrotoxicity and hence should be used instead of joint infiltration.