Wrist Arthroscopy

Updated: Nov 23, 2022
  • Author: John J Walsh, IV, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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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.

The wrist is a complex joint that continues to challenge clinicians. This joint consists of eight 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.

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. [1]

Historically, tricompartmental wrist arthrography has been the criterion standard for the detection of intra-articular pathology. 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. [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13] A study by Cheriex et al concluded that cineradiography also has a high success rate in detecting scapholunate dissociation. [14] Plain x-rays and computed tomography (CT) arthrography are insufficient diagnostic tools. [15]

Wrist arthroscopy is growing in popularity as a feasible adjunct in the management of disorders of the wrist. [16, 17] The procedure enables evaluation and detection of carpal structures under bright magnifying conditions with minimal morbidity as compared with arthrotomy. Improved wrist arthroscopic techniques continue to emerge as more surgeons are exposed to wrist arthroscopy and new instrumentation is developed. Despite short-term follow-up, the results of one study add another technique, arthroscopic resection arthroplasty, to the treatment algorithm of the very common pantrapezial arthritis. [18]

For patient education resources, see Wrist Injury and Carpal Tunnel Syndrome.



The indications and applications for wrist arthroscopy continue to expand as new techniques and instrumentation evolve. 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.

Therapeutically, 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), [19] and stabilization of interosseous ligaments, as well as other conditions (eg, Kienböck disease [20] ).


Technical Considerations


The TFCC is a homogeneous structure comprising the following components [21] :

  • Articular disk
  • Dorsal and volar radioulnar ligaments
  • Ulnar collateral ligament
  • Sheath of the extensor carpi ulnaris
  • Meniscal homologue

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 (DRUJ). 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. [21]

The articular disk 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 DRUJ. Palmer proposed a classification system for TFCC tears, which divided the injuries into two categories: traumatic (class I) and degenerative (class II). (See Technique.) [21] For more information, also see Wrist Joint Anatomy.



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

In a study of 55 patients who underwent arthroscopic resection for dorsal wrist ganglion cysts, Edwards et al noted a significant increase in function and a significant decrease in pain within 6 weeks after the procedure. [22] At 2 years after surgery, all patients had wrist motion that was within 5º 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.

Adolfsson used arthroscopy to examine 144 patients who had posttraumatic wrist pain but normal findings on standard radiographs. [23] During the procedure, ligamentous changes were observed in 75 patients, TFCC lesions (including lunotriquetral instability) in 61, and degrees of scapholunate instability in 14.

The results of one small study found that arthroscopic proximal-row carpectomy can be a safe and reliable alternative to the open procedure. Range of motion and grip strength compared favorably, and mobilization of the wrist was improved over the open technique. [24]

Noback et al studied 13 patients with stage 2 or 3 SLAC wrist treated with arthroscopic wrist debridement and radial styloidectomy and concluded that the procedure relieved pain but did not necessarily avoid the need for future procedures. [25]

Soreide et al studied 15 patients with a median follow-up duration of 20 years. Their findings show that arthroscopically assisted resection of selected TFCC lesions is safe and efficient. [26, 27]

Trehan et al, in a study assessing outcomes of arthroscopic TFCC surgery in 43 pediatric and adolescent patients (44 wrists), found that at final follow-up, the mean QuickDASH score was 4, the Patient-Rated Wrist Evaluation was 8, and patient and parent satisfaction scores were both 9/10. [28]