Wrist Arthroscopy 

  • Author: William Geissler, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Nov 21, 2011
 

Background

Surgical visualization by means of arthroscopy has revolutionized orthopedics by allowing direct treatment of intra-articular pathology. Wrist arthroscopy evolved from the successful application of arthroscopy in larger joints. Arthroscopy images are depicted below.

Arthroscopic image of the radial radiocarpal jointArthroscopic image of the radial radiocarpal joint. The radioscaphocapitate ligament is the most volar radial extrinsic wrist ligament. Adjacent and ulnar to the radioscaphocapitate ligament, the long radiolunate ligament is depicted. Note that the long radiolunate ligament is larger. The scaphoid is depicted above. The short radiolunate ligament appears as a vasculThe short radiolunate ligament appears as a vascularized tuft. It is ulnar to the long radiolunate ligament. Grade III scapholunate tear, as depicted from the Grade III scapholunate tear, as depicted from the midcarpal space. Note that the gap allows passage of a 1-mm probe.

The wrist is a complex joint that continues to challenge clinicians. This joint consists of 8 carpal bones, multiple articular surfaces with extrinsic and intrinsic ligaments, and a triangular fibrocartilage complex (TFCC)—all within a 5-cm interval. Surgeons who use wrist arthroscopy are able to directly visualize cartilage, synovial tissue, and ligaments under bright illumination and magnification.

Recent studies

Sammer and Shin, in their study of 36 patients with septic arthritis of the wrist, found arthroscopic irrigation and debridement (19 patients) to be effective in patients with isolated disease; arthroscopy was associated with fewer operations and a shorter hospital than open treatment (17 patients). However, these benefits were not seen in patients who had multiple sites of infection.[1]

In a study of 55 patients who underwent arthroscopic resection for dorsal wrist ganglion cysts, Edwards and Johansen found that patients had a significant increase in function and a significant decrease in pain within 6 weeks after the procedure. At 2 years after surgery, all patients had wrist motion that was within 5 º of preoperative motion; there were no recurrences. The authors noted that recurrent ganglion cysts originating from the midcarpal joint are not contraindications for arthroscopic resection, that assessment of the midcarpal joint is necessary for complete resection of most ganglion cysts, and that identification of a discrete stalk is an uncommon finding and is not necessary for successful resection.[2]

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History of the Procedure

Most acute wrist sprains in which radiographic findings are normal resolve after conservative measures. However, the evaluation of the patient who does not improve after such treatment is controversial.[3] Historically, tricompartmental wrist arthrography has been the criterion standard for the detection of intra-articular pathology.[4, 5, 6] Wrist arthroscopy, which can be used simultaneously to detect and treat wrist injuries, and magnetic resonance imaging (MRI) have changed the way in which wrist pathology is treated.[7, 8, 9, 10, 11, 12, 13]

Adolfsson used arthroscopy to examine 144 patients who had posttraumatic wrist pain but normal findings on standard radiographs.[14] During the procedure, ligamentous changes were observed in 75 patients, TFCC lesions (including lunotriquetral instability) in 61 patients, and degrees of scapholunate instability in 14 patients.

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Problem

The wrist is a complex joint that continues to challenge clinicians.

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Indications

The indications and applications for wrist arthroscopy continue to expand as new techniques and instrumentation evolve. Operative intervention is indicated for treatment of intra-articular fractures of the distal radius and scaphoid, wrist lavage, synovectomy (ie, rheumatoid arthritis), ganglionectomy, distal ulnar shortening, detection and removal of loose bodies, debridement of degenerative arthritis, debridement and repair of the TFCC, resection arthroplasty (proximal row carpectomy), management of septic arthritis (arthroscopic incision and drainage),[1] and stabilization of interosseous ligaments, as well as other conditions.

Diagnostically, wrist arthroscopy can allow for assessing interosseous ligament tears and determining whether the tears are partial or complete, evaluating the TFCC, inspecting for chondral defects in the carpal and midcarpal space, and evaluating chronic wrist pain of unknown etiology.

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Relevant Anatomy

The TFCC is a homogeneous structure composed of (1) the articular disc, (2) the dorsal and volar radioulnar ligaments, (3) the ulnar collateral ligament, (4) the sheath of the extensor carpi ulnaris, and (5) the meniscal homologue.[15] The TFCC acts as an extension of the articular surface of the radius to support the proximal carpal row, and it also provides stability to the distal radioulnar joint. The volar carpal ligaments assist in limiting wrist extension and radial deviation, as well as assist in stabilizing the volar-ulnar aspect of the carpus. Approximately 20% of the load of the forearm is transferred through the ulnar side of the wrist and the TFCC.[15]

The articular disc has thickening of the volar and dorsal margins, which are known as the volar and dorsal radioulnar ligaments. These ligaments assist in providing stability to the distal radioulnar joint. Palmer proposed a classification system for triangular fibrocartilage tears, which divided the injuries into 2 categories: traumatic (class I) and degenerative (class II) (see Table in Surgical Therapy section below).[15] For more information, also see Wrist Joint Anatomy.

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Contributor Information and Disclosures
Author

William Geissler, MD  Professor of Orthopedic Surgery, Chief, Division of Hand/Upper Extremity Surgery, Chief, Sports Medicine, Arthroscopic Surgery, Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center

William Geissler, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Mississippi Orthopaedic Society, Mississippi State Medical Association, Society of Tennis Medicine and Science, and Southern Orthopaedic Association

Disclosure: Acumed Royalty Consulting

Coauthor(s)

John J Walsh IV, MD  Professor and Chairman, Department of Orthopedic Surgery, University of South Carolina School of Medicine

John J Walsh IV, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Specialty Editor Board

A Lee Osterman, MD  Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert J Nowinski, DO  Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Ohio Osteopathic Association, and Ohio State Medical Association

Disclosure: Tornier Grant/research funds Other; Tornier Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Sammer DM, Shin AY. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. J Bone Joint Surg Am. Jun 2009;91(6):1387-93. [Medline].

  2. Edwards SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am. Mar 2009;34(3):395-400. [Medline].

  3. Chloros GD, Shen J, Mahirogullari M, Wiesler ER. Wrist arthroscopy. J Surg Orthop Adv. 2007;16(2):49-61. [Medline].

  4. Chung KC, Zimmerman NB, Travis MT. Wrist arthrography versus arthroscopy: a comparative study of 150 cases. J Hand Surg [Am]. Jul 1996;21(4):591-4. [Medline].

  5. Cooney WP. Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy. J Hand Surg [Am]. Sep 1993;18(5):815-22. [Medline].

  6. Pederzini L, Luchetti R, Soragni O, et al. Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging. Arthroscopy. 1992;8(2):191-7. [Medline].

  7. Moser T, Dosch JC, Moussaoui A, Dietemann JL. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol. May 2007;188(5):1278-86. [Medline].

  8. Zanetti M, Saupe N, Nagy L. Role of MR imaging in chronic wrist pain. Eur Radiol. Apr 2007;17(4):927-38. [Medline].

  9. Tanaka T, Yoshioka H, Ueno T, Shindo M, Ochiai N. Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury. J Hand Surg [Am]. Oct 2006;31(8):1308-14. [Medline].

  10. Johnstone DJ, Thorogood S, Smith WH, Scott TD. A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg [Br]. Dec 1997;22(6):714-8. [Medline].

  11. Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol. Jun 1997;168(6):1513-8. [Medline]. [Full Text].

  12. Potter HG, Asnis-Ernberg L, Weiland AJ, et al. The utility of high-resolution magnetic resonance imaging in the evaluation of the triangular fibrocartilage complex of the wrist. J Bone Joint Surg Am. Nov 1997;79(11):1675-84. [Medline].

  13. Joshy S, Lee K, Deshmukh SC. Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop. Jan 11 2007;[Medline].

  14. Adolfsson L. Arthroscopic diagnosis of ligament lesions of the wrist. J Hand Surg [Br]. Aug 1994;19(4):505-12. [Medline].

  15. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg [Am]. Jul 1989;14(4):594-606. [Medline].

  16. Geissler WB, Fernandez DL, Lamey DM. Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res. Jun 1996;327:135-46. [Medline].

  17. Whipple TL. The role of arthroscopy in the treatment of scapholunate instability. Hand Clin. Feb 1995;11(1):37-40. [Medline].

  18. Osterman AL, Seidman GD. The role of arthroscopy in the treatment of lunatotriquetral ligament injuries. Hand Clin. Feb 1995;11(1):41-50. [Medline].

  19. Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg [Am]. Mar 1997;22(2):344-9. [Medline].

  20. Buterbaugh GA. Radiocarpal arthroscopy portals and normal anatomy. Hand Clin. Nov 1994;10(4):567-76. [Medline].

  21. Botte MJ, Cooney WP, Linscheid RL. Arthroscopy of the wrist: anatomy and technique. J Hand Surg [Am]. Mar 1989;14(2 pt 1):313-6. [Medline].

  22. Budoff JE, Gordon L. Wrist arthroscopy using a shoulder traction boom. Am J Orthop. Dec 2008;37(12):614-5. [Medline].

  23. Roth JH, Poehling GG, Whipple TL. Hand instrumentation for small joint arthroscopy. Arthroscopy. 1988;4(2):126-8. [Medline].

  24. del Piñal F, García-Bernal FJ, Pisani D, et al. Dry arthroscopy of the wrist: surgical technique. J Hand Surg [Am]. Jan 2007;32(1):119-23. [Medline].

  25. Ekman EF, Poehling GG. Principles of arthroscopy and wrist arthroscopy equipment. Hand Clin. Nov 1994;10(4):557-66. [Medline].

  26. Berger RA, Landsmeer JM. The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surg [Am]. Nov 1990;15(6):847-54. [Medline].

  27. Slutsky DJ. Distal radioulnar joint arthroscopy and the volar ulnar portal. Tech Hand Up Extrem Surg. Mar 2007;11(1):38-44. [Medline].

  28. Bettinger PC, Cooney WP, Berger RA. Arthroscopic anatomy of the wrist. Orthop Clin North Am. Oct 1995;26(4):707-19. [Medline].

  29. North ER, Thomas S. An anatomic guide for arthroscopic visualization of the wrist capsular ligaments. J Hand Surg [Am]. Nov 1988;13(6):815-22. [Medline].

  30. Viegas SF. Midcarpal arthroscopy: anatomy and portals. Hand Clin. 10(4);1994 Nov:577-87. [Medline].

  31. Whipple TL. The role of arthroscopy in the treatment of wrist injuries in the athlete. Clin Sports Med. Jul 1998;17(3):623-34. [Medline].

  32. Corso SJ, Savoie FH, Geissler WB, et al. Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy. Feb 1997;13(1):78-84. [Medline].

  33. Whipple TL, Cooney WP 3rd, Osterman AL, Viegas SF. Wrist arthroscopy. Instr Course Lect. 1995;44:139-45. [Medline].

  34. Whipple TL. Arthroscopic surgery. The Wrist. Philadelphia, Pa: JB Lippincott; 1992:103-5.

  35. Hermansdorfer JD, Kleinman WB. Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg [Am]. Mar 1991;16(2):340-6. [Medline].

  36. Chow JC. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy. 1989;5(1):19-24. [Medline].

  37. Sagerman SD, Short W. Arthroscopic repair of radial-sided triangular fibrocartilage complex tears. Arthroscopy. Jun 1996;12(3):339-42. [Medline].

  38. Fellinger M, Peicha G, Seibert FJ, Grechenig W. Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: a new technique for arthroscopic repair. Arthroscopy. Jun 1997;13(3):370-4. [Medline].

  39. Trumble TE, Gilbert M, Vedder N. Ulnar shortening combined with arthroscopic repairs in the delayed management of triangular fibrocartilage complex tears. J Hand Surg [Am]. Sep 1997;22(5):807-13. [Medline].

  40. Wnorowski DC, Palmer AK, Werner FW, Fortino MD. Anatomic and biomechanical analysis of the arthroscopic wafer procedure. Arthroscopy. 1992;8(2):204-12. [Medline].

  41. Nagle DJ. Laser-assisted wrist arthroscopy. Hand Clin. Aug 1999;15(3):495-9, ix. [Medline].

  42. Nagle DJ. The use of lasers in wrist arthroscopy. Presented at: Annual Meeting of the Arthroscopy Association of North America; 1997; Rosemont, IL.

  43. Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin. Feb 1995;11(1):7-12. [Medline].

  44. Anderson DD, Bell AL, Gaffney MB, Imbriglia JE. Contact stress distributions in malreduced intraarticular distal radius fractures. J Orthop Trauma. 1996;10(5):331-7. [Medline].

  45. Baratz ME, Des Jardins J, Anderson DD, Imbriglia JE. Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. J Hand Surg [Am]. Mar 1996;21(2):183-8. [Medline].

  46. Wagner WF Jr, Tencer AF, Kiser P, Trumble TE. Effects of intra-articular distal radius depression on wrist joint contact characteristics. J Hand Surg [Am]. Jul 1996;21(4):554-60. [Medline].

  47. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. Jun 1986;68(5):647-59. [Medline].

  48. Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 1999;48:465-80. [Medline].

  49. Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg [Am]. Mar 1994;19(2):325-40. [Medline].

  50. Levy HJ, Glickel SZ. Arthroscopic assisted internal fixation of volar intraarticular wrist fractures. Arthroscopy. 1993;9(1):122-4. [Medline].

  51. Llinas A, McKellop HA, Marshall GJ, et al. Healing and remodeling of articular incongruities in a rabbit fracture model. J Bone Joint Surg Am. Oct 1993;75(10):1508-23. [Medline].

  52. Geissler WB, Fernandez DL. Percutaneous and limited open reduction of the articular surface of the distal radius. J Orthop Trauma. 1991;5(3):255-64. [Medline].

  53. Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop Relat Res. Jun 1996;327:125-34. [Medline].

  54. Whipple TL. The role of arthroscopy in the treatment of intra-articular wrist fractures. Hand Clin. Feb 1995;11(1):13-8. [Medline].

  55. Geissler WB. Arthroscopically assisted reduction of intra-articular fractures of the distal radius. Hand Clin. Feb 1995;11(1):19-29. [Medline].

  56. Geissler WB, Savoie FH. Arthroscopic techniques of the wrist. Medi-guide Orthop. 1992;11:1-8.

  57. Geissler WB, Freeland AE, Savoie FH, et al. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. Mar 1996;78(3):357-65. [Medline].

  58. Richards RS, Bennett JD, Roth JH, Milne K Jr. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg [Am]. Sep 1997;22(5):772-6. [Medline].

  59. Hanker GJ. Wrist arthroscopy in distal radius fractures. Presented at: Annual Meeting of the Arthroscopy Association of North America; October 9, 1993; Albuquerque, NM.

  60. Kolkin L. Wrist arthroscopy. Presented at: Annual Meeting of the American Academy of Orthopaedic Surgeons; February 23, 1992; Washington, DC.

  61. Fontes D, Lenoble E, de Somer B, Benoit J. [Lesions of the ligaments associated with distal fractures of the radius. 58 intraoperative arthrographies]. [French]. Ann Chir Main Memb Super. 1992;11(2):119-25. [Medline].

  62. Hixon ML, Walker CW, Fitzrandolph RL, McAndrew M. Acute ligament tears of the wrist associated with Colles' fracture. Orthop Trans. 1990;14:164-5.

  63. Hollingsworth R, Morris J. The importance of the ulnar side of the wrist in fractures of the distal end of the radius. Injury. May 1976;7(4):263-6. [Medline].

  64. Mudgal CS, Jones WA. Scapho-lunate diastasis: a component of fractures of the distal radius. J Hand Surg [Br]. Nov 1990;15(4):503-5. [Medline].

  65. Mohanti RC, Kar N. Study of triangular fibrocartilage of the wrist joint in Colles' fracture. Injury. May 1980;11(4):321-4. [Medline].

  66. Geissler WB. Arthroscopic management of scaphoid fractures in athletes. Hand Clin. Aug 2009;25(3):359-69. [Medline].

  67. Yassaee F, Yang SS. Mini-incision fixation of nondisplaced scaphoid fracture nonunions. J Hand Surg Am. Sep 2008;33(7):1116-20. [Medline].

  68. Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg Br. Jan 1998;80(1):95-9. [Medline].

  69. Slade JF 3rd, Gutow AP, Geissler WB. Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2002;84-A(suppl 2):21-36. [Medline].

  70. Cobb T, Sterbank P, Lemke J. Arthroscopic resection arthroplasty for treatment of combined carpometacarpal and scaphotrapeziotrapezoid (pantrapezial) arthritis. J Hand Surg Am. Mar 2011;36(3):413-9. [Medline].

  71. Weiss ND, Molina RA, Gwin S. Arthroscopic proximal row carpectomy. J Hand Surg Am. Apr 2011;36(4):577-82. [Medline].

  72. Abe Y, Katsube K, Tsue K, Doi K, Hattori Y. Arthoscopic diagnosis of partial scapholunate ligament tears as a cause of radial sided wrist pain in patients with inconclusive x-ray and MRI findings. J Hand Surg [Br]. Aug 2006;31(4):419-25. [Medline].

  73. Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg [Am]. Nov 1976;1(3):228-35. [Medline].

  74. Aviles AJ, Lee SK, Hausman MR. Arthroscopic reduction-association of the scapholunate. Arthroscopy. Jan 2007;23(1):105.e1-5. Epub 2006 Oct 16. [Medline].

  75. Bickel KD. Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. Oct 2008;33(8):1420-3. [Medline].

  76. Coggins CA. Imaging of ulnar-sided wrist pain. Clin Sports Med. Jul 2006;25(3):505-26, vii. [Medline].

  77. Earp BE, Waters PM, Wyzykowski RJ. Arthroscopic treatment of partial scapholunate ligament tears in children with chronic wrist pain. J Bone Joint Surg Am. Nov 2006;88(11):2448-55. [Medline].

  78. Garcia-Elias M, Folgar MA. The management of wrist injuries: an international perspective. Injury. Nov 2006;37(11):1049-56. [Medline].

  79. Geissler WB. Arthroscopic excision of dorsal wrist ganglia. Tech Upper Extrem Surg. 1998;2:196-201.

  80. Hardy P, Gomes N, Chebil M, Bauer T. Wrist arthroscopy and intra-articular fractures of the distal radius in young adults. Knee Surg Sports Traumatol Arthrosc. Nov 2006;14(11):1225-30. [Medline].

  81. Hulsizer D, Weiss AP, Akelman E. Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg [Am]. Jul 1997;22(4):694-8. [Medline].

  82. Kreder HJ, Hanel DP, McGee M, et al. Limited open versus standard open reduction and internal fixation of intra-articular fractures of the radius: a prospective randomized trial. Presented at: Annual Meeting of the Canadian Orthopaedic Association; February 5, 1998; Auckland, New Zealand.

  83. Osterman AL. Arthroscopic debridement of triangular fibrocartilage complex tears. Arthroscopy. 1990;6(2):120-4. [Medline].

  84. Roth JH, Poehling GG. Arthroscopic "-ectomy" surgery of the wrist. Arthroscopy. 1990;6(2):141-7. [Medline].

  85. Schädel-Höpfner M, Böhringer G, Gotzen L. [Percutaneous osteosynthesis of scaphoid fracture with the Herbert-Whipple screw--technique and results]. [German]. Handchir Mikrochir Plast Chir. Jul 2000;32(4):271-6. [Medline].

  86. Trumble TE, Gilbert M, Vedder N. Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg [Am]. Jan 1997;22(1):57-65. [Medline].

  87. Weiss AP, Akelman E, Lambiase R. Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy. J Bone Joint Surg Am. Mar 1996;78(3):348-56. [Medline].

  88. Whipple TL. TFCC injury: biomechanics, classification and treatment with Whipple technique. In: Chow JCY, ed. Advanced Arthroscopy. New York, NY: Springer-Verlag; 2001:203.

  89. Whipple TL, Marotta JJ, Powell JH. Techniques of wrist arthroscopy. Arthroscopy. 1986;2(4):244-52. [Medline].

  90. Wolfe SW, Easterling KJ, Yoo HH. Arthroscopic-assisted reduction of distal radius fractures. Arthroscopy. Dec 1995;11(6):706-14. [Medline].

 
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Traction tower after draping.
The wrist is suspended in the traction tower, and the portals are drawn with the associated landmarks on the extensor surface of the wrist.
The wrist is suspended in the traction tower, and the portals are drawn with the associated landmarks on the extensor surface of the wrist.
Arthroscopic image of the radial radiocarpal joint. The radioscaphocapitate ligament is the most volar radial extrinsic wrist ligament. Adjacent and ulnar to the radioscaphocapitate ligament, the long radiolunate ligament is depicted. Note that the long radiolunate ligament is larger. The scaphoid is depicted above.
The short radiolunate ligament appears as a vascularized tuft. It is ulnar to the long radiolunate ligament.
Trampoline test. Similar to a trampoline, the disc of the triangular fibrocartilage complex should be taut when probed.
Lunotriquetral ligament, as depicted from the 4-5 portal in the radiocarpal space.
Grade III scapholunate tear, as depicted from the midcarpal space. Note that the gap allows passage of a 1-mm probe.
Grade IV scapholunate tear, as depicted from the midcarpal space. A 2.7-mm arthroscope may be freely passed through the tear.
Posteroanterior radiograph of a wrist. Abnormal widening between the scaphoid and lunate is present, indicating a complete scapholunate tear.
Electrothermal shrinkage performed in a patient with dynamic carpal instability. Careful use of the probe is required to avoid damage to critical structures.
Class IA tear of the triangular fibrocartilage complex. The probe points at the tear.
Arthroscopic debridement in a class IA tear. The flap has been debrided, and the arthroscope is used to smooth the remaining disc.
Class 1B tear, as depicted from the 3-4 portal. Reactive synovitis may cover the tear.
Repair of a class IB tear with the outside-in technique. A small, longitudinal incision incorporates the 6-R portal.
Arthroscopic image of a cannulated needle piercing the articular disc in a class IB repair.
Arthroscopic view reveals retrieval of the suture with a small joint grasper.
Sutures placed before being tied in a class IB tear.
Class ID tear. Avulsion of the disc from the sigmoid notch is depicted.
Arthroscopic image of the rim of the sigmoid notch, which is debrided to a bleeding bone bed before reattachment of the disc.
Class IIC tear of the triangular fibrocartilage complex. Note the chondromalacia of the ulna.
Radiocarpal view after arthroscopic removal of the ganglion stalk.
Arthroscopic view demonstrating the articular step-off in a distal radius fracture. Hematoma and debris are removed for optimal visualization.
Radiograph of a wrist after arthroscopic-assisted pinning of an intra-articular distal radius fracture
Before the scaphoid is pinned, the wrist is flexed at 45 degrees, which places the scaphoid in 90 degrees flexion.
Fluoroscopic image demonstrates reaming of the scaphoid in a proximal-to-distal fashion after arthroscopic reduction and percutaneous pinning.
Anteroposterior radiograph after reduction and fixation with a headless screw.
Lateral radiograph after reduction and fixation with a headless screw.
Table. Arthroscopic classification of carpal interosseous ligament tears (Adapted from Geissler et al.[16] )
GradeDescriptionManagement
IAttenuation and/or hemorrhage of the interosseous ligament as observed from the radiocarpal joint. No incongruence of carpal alignment in midcarpal space. Immobilization
IIAttenuation and/or hemorrhage of the interosseous ligament, as observed from the radiocarpal joint. Incongruence and/or step-off, as observed from the midcarpal space. A slight gap (less than the width of a probe) between the carpals may be present. Arthroscopic reduction and pinning
IIIIncongruence and/or step-off of the carpal alignment are observed in both the radiocarpal and midcarpal space. The probe may be passed through a gap between the carpals. Arthroscopic reduction and/or open reduction and pinning
IVIncongruence and/or step-off of the carpal alignment are observed in both the radiocarpal and midcarpal space. Gross instability with manipulation is noted. A 2.7-mm arthroscope may be passed through the gap between the carpals. Open reduction and repair
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