Wrist Arthroscopy

Arthroscopy is a surgical procedure used to visualize, diagnose, and treat problems inside a joint. The procedure involves making a small incision in the skin and inserting a pencil-sized camera into an injured or damaged joint. The arthroscope’s tiny camera and instrumentation allow Dr. Samimi to see inside the joint in a magnified and illuminated manner to accurately diagnose and effectively treat the condition. Dr. Samimi specializes in the treatment of complex and routine wrist problems that may be treated with arthroscopic techniques.

Technological advances such as high definition monitors and high resolution cameras have made arthroscopy a very effective tool for treating a variety of wrist problems.

Arthroscopy is almost always performed as outpatient surgery and offers such benefits as reduced risk, fewer complications, less postoperative pain, less recovery time, and far less scarring. Using this minimally invasive procedure we can perform wrist surgeries such TFCC repair or debridement, and ganglion cyst excision.

What happens during the procedure?

Dr. Samimi uses arthroscopy to feel, repair or remove damaged tissue.

First, we examine your wrist with the arthroscope. The arthroscope is inserted into your wrist through a small incision large enough to fit the small camera. The arthroscope is connected to a video monitor in the operating room. All the tissues of your wrist joint -- the cartilage, TFCC, and ligaments are inspected.

Once a thorough understanding of the problem is obtained, damaged tissues are either removed or repaired. To do this, small surgical instruments such as scissors, graspers, or motorized shavers are inserted into the wrist joint through these same small incisions. Usually 2 to 3 small incisions are all that are needed in wrist arthroscopy.

The procedure usually lasts 30 minutes to an hour depending on the findings and the treatment necessary.

At the end of the surgery, your incisions will be closed with stitches and covered with a dressing (bandage). Almost all arthroscopic wrist surgery is done on an outpatient basis. Typically you will go home the same day followed by a course of physical therapy. You will be given a wrist splint that is worn usually for one week after surgery.

Indications:

Arthroscopic surgery can be used to treat a number of conditions of the wrist. These include chronic (long-term) wrist pain, wrist fractures, ganglion cysts, ligament tears, and tears of the triangular fibrocartilage complex (TFCC). Wrist arthroscopy may also be used to smooth bone surfaces and remove inflamed tissue.

Chronic wrist pain: Arthroscopic surgery may be used to diagnose the cause of chronic wrist pain when the results of other tests do not provide a clear diagnosis. Often, there may be areas of inflammation, cartilage damage, or other findings after a wrist injury. In some cases, after the diagnosis is made, the condition can be treated arthroscopically as well.

Wrist fractures: Small fragments of bone may stay within the joint after a bone breaks (fractures). Wrist arthroscopy can remove these fragments, align the broken pieces of bone, and stabilize them by using pins, wires, or screws.

Ganglion cysts: Ganglion cysts commonly grow from a stalk between two of the wrist bones. During an arthroscopic procedure, the surgeon can remove the cyst.

Ligament/TFCC tears: Ligaments are fibrous bands of connective tissue that link or hinge bones. They provide stability and support to the joints. The triangular fibrocartilage complex (TFCC) is a cushioning structure within the wrist. A fall on an outstretched hand can tear ligaments, the TFCC, or both. The result is pain with movement or a clicking sensation. During arthroscopic surgery, the surgeon can repair the tears.

Carpal tunnel release: Carpal tunnel syndrome is characterized by numbness or tingling in the hand, and sometimes with pain up the arm. It is caused by pressure on a nerve that passes through the carpal tunnel. (The carpal tunnel is formed by the wrist bones and a thick tissue roof.) Pressure can build up within the tunnel for many reasons, including irritation and swelling of the tissue (synovium) that covers the tendons. If the carpal tunnel syndrome does not respond to nonsurgical treatment, the next option is to treat the area surgically by cutting the ligament roof and enlarging the tunnel. This would reduce pressure on the nerve and relieve symptoms. This can sometimes be done using an arthroscope.