Wrist arthroscopy
Definition
Wrist arthroscopy is surgery that uses a tiny camera and surgical tools to examine or repair the tissues inside or around your wrist. The camera is called an arthroscope. The procedure allows your surgeon to detect problems and make repairs to the wrist without making larger cuts in the skin and tissue. This means that you may have less pain and recover more quickly than open surgery.
Alternative Names
Wrist surgery; Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release
Description
You may receive general anesthesia before this surgery. This means you will be asleep and unable to feel pain. Or, you will have regional anesthesia. This means your arm and wrist area will be numbed so that you do not feel any pain. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.
During the procedure, the surgeon does the following:
- Inserts the arthroscope into your wrist through a small incision. The scope is connected to a video monitor in the operating room. This allows the surgeon to view the inside of your wrist.
- Inspects all the tissues of your wrist. These tissues include cartilage, bones, tendons, and ligaments.
- Repairs any damaged tissues. To do this, your surgeon makes 1 to 3 more small incisions and inserts other instruments through them. A tear in a muscle, tendon, or cartilage is fixed. Any damaged tissue is removed.
At the end of the surgery, the incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and what repairs they made.
Your surgeon may need to do open surgery if there is a lot of damage. Open surgery means you will have a large incision so that the surgeon can get directly to your bones and tissues.
Why the Procedure Is Performed
You might need wrist arthroscopy if you have one of these problems or procedures:
- Wrist pain. Arthroscopy allows the surgeon to explore what is causing your wrist pain.
- Ganglion removal. This is a small, fluid-filled sac that grows from the wrist joint. It is harmless, but it can be painful and can limit your ability to move your wrist freely.
- Ligament tears. A ligament is a band of tissue that connects bone to bone. Several ligaments in the wrist help keep it stable and allow it to move. Torn ligaments can be repaired with this type of surgery.
- Triangular fibrocartilage complex (TFCC) tear. The TFCC is a cartilage area in the wrist. Injury to the TFCC can cause pain on the outer aspect of the wrist. Arthroscopy can repair damage of the TFCC.
- Carpal tunnel release. Carpal tunnel syndrome occurs when the nerve that passes through certain bones and tissues in your wrist becomes swollen and irritated. With arthroscopy the area through which this nerve passes can be made larger to relieve the pressure and pain.
- Wrist fractures. Arthroscopy can be used to remove small bits of bone and help realign the bones in your wrist.
- Arthritis. Arthroscopy can be used to remove tissues inside the arthritic joint and create more space.
Risks
Risks of anesthesia and surgery in general are:
- Allergic reactions to medicines
- Breathing problems
- Bleeding, blood clot, or infection
Risks of wrist arthroscopy are:
- Failure of surgery to relieve symptoms
- Failure of repair to heal
- Weakness of the wrist
- Injury to a tendon, blood vessel, or nerve
Before the Procedure
Before the surgery:
- Tell your surgeon what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
- You may be asked to temporarily stop taking blood thinners. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other medicines.
- Ask your surgeon which medicines you should still take on the day of your surgery.
- If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your health care provider who treats you for these conditions.
- Tell your provider if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
- If you smoke, try to stop. Ask your provider or nurse for help. Smoking can slow wound and bone healing.
- Tell your surgeon about any cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.
On the day of surgery:
- Follow instructions about when to stop eating and drinking before the procedure.
- Take any medicine you're asked to take with a small sip of water.
- Follow instructions on when to arrive at the hospital. Arrive on time.
After the Procedure
You can go home the same day after spending an hour or so in recovery. You should have someone drive you home.
Follow any discharge instructions you're given. These may include:
- Keep your wrist elevated above your heart for 2 to 3 days to help reduce swelling and pain. You can also apply a cold pack to help with swelling.
- Keep your bandage clean and dry. Follow instructions for how to change the dressing.
- You can take pain relievers, if needed, as long as your provider says it's safe to do so.
- You may need to wear a splint for 1 to 2 weeks or longer to keep the wrist stable as it heals.
Outlook (Prognosis)
Arthroscopy uses small cuts in the skin, so compared to open surgery, you may have:
- Less pain and stiffness during recovery
- Fewer complications
- Faster recovery
The small cuts will heal quickly and you may be able to resume your normal activities in a few days. But, if a lot of tissue in your wrist had to be repaired, it may take several weeks to heal.
You may be shown how to do gentle exercises with your fingers and hand. Your provider may also recommend that you see a hand therapist to help you regain the full use of your wrist.
References
Geissler WB, Rush DA, Keen CA. Wrist arthroscopy. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 69.
Weller WJ. Wrist disorders. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 69.
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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