The wrist is distinguished by its multi-level structure and peculiar shape, with a large number of wrist rows and a complex of external and internal ligaments, which is one of the most complex anatomical structures of the entire human musculoskeletal system.
Features of the structure and function of the wrist explain its various injuries, as well as the difficulties and problems of diagnosing and treating the pathology of this anatomical region. Arthroscopy has become one of the relatively new techniques in the diagnosis of injuries to the wrist area in recent years. For a decade, arthroscopy has made significant progress in its development providing accurate diagnosis of wrist traumas.
Compared to open surgery, wrist arthroscopy is much more gentle. The minimally invasive surgery is characterized by small incisions and a fast healing process. Thanks to modern technology, wrist arthroscopy of even the smallest joints is possible. The fragile structure of the hand, such as the small joints of the fingers, is thus exposed to a minimal risk of injury during wrist arthroscopy.
Wrist arthroscopy is performed under anesthesia. The patient is on the operating table in a supine position during surgery. The arm is abducted at 90 degrees in the shoulder and bent at the elbow joint, the fingers are fixed with a special retainer, which is attached to a bar that is screwed to the operating table and allows maintaining the vertical position of the forearm and wrist. A pneumatic cuff is installed at the level of the middle third of the shoulder in order to exsanguinate the wrist.
Since the wrist joint has a relatively small size(about 5-8 ml), for effective examination and wrist arthroscopy in the joint cavity with various arthroscopic instruments, the joint area is stretched using weights up to 7 kg.
Two or three small (5-7 mm) skin incisions are made in the joint area during wrist arthroscopy. Through one of these incisions, an arthroscope is inserted into the joint cavity of the wrist, which is a tube several millimeters in diameter equipped with an optical system and a light source. The arthroscope is connected to a miniature video camera, the image from which is transmitted to the video screen.
Through other incisions, fluid is pumped into the joint to facilitate examination, and surgical instruments are introduced, with the help of which, if necessary, the surgery is carried out. At the end of the wrist arthroscopy, stitches are applied to the incisions, which are removed 10-14 days after the surgery.
What is the Result?
In the postoperative period of arthroscopy, the wrist is immobilized with a palmar plaster splint or orthosis for a week. Also, a rehabilitation program may be recommended, including a course of physiotherapy to restore the regular functioning and strengthen the muscles.
Most often, patients return to their normal lives very quickly, but in some cases, the recovery period after wrist arthroscopy takes up to a week or longer. The main advantages of wrist arthroscopy are its highest diagnostic efficiency and low invasiveness of manipulations.
Complications from the surgery are extremely rare and can include infection, bleeding, damage to blood vessels, nerves, or wrist tendons. Thus, today arthroscopy is the most effective way to diagnose and treat many diseases and injuries of the joints, including the wrist, allowing a completely different development of the patient’s treatment program, which is of great practical and prognostic importance.