Wrist Arthroscopy
Minimally invasive keyhole surgery for diagnosis and treatment of wrist conditions. Complete guide to indications, techniques, and recovery.
Understanding Wrist Arthroscopy
Wrist arthroscopy has revolutionized the diagnosis and treatment of wrist disorders. Using a small camera and specialized instruments inserted through tiny incisions (portals), surgeons can directly visualize all areas of the wrist joint with magnification, allowing precise diagnosis and treatment.
Evolution: First performed in the 1970s, wrist arthroscopy has evolved from a diagnostic tool to a therapeutic procedure for many conditions. Advances in instrumentation and technique have expanded its applications significantly.
Advantages: Smaller incisions mean less damage to surrounding tissues, faster healing, reduced scarring, and often earlier return to function. The magnified view can reveal pathology not visible on MRI or during open surgery.
Common Indications
- • Unexplained chronic wrist pain
- • Staging of arthritis
- • Ligament injury assessment
- • Evaluation when imaging inconclusive
- • Second-look after previous surgery
- • TFCC tear repair/debridement
- • Ganglion cyst excision
- • Loose body removal
- • Synovectomy for RA/synovitis
- • Ligament debridement/thermal shrinkage
- • Fracture reduction assistance
- • Articular cartilage procedures
Surgical Technique
Anesthesia: Usually regional (arm block) or general anesthesia. Regional allows evaluation of patient-reported symptoms during surgery.
Setup: Wrist is suspended with finger traps. Traction applied to open joint space. Arm in sterile drapes.
Portals (access points):
- 3-4 portal: Between 3rd and 4th extensor compartments - main viewing portal
- 4-5 portal: Main working portal
- 6R portal: For ulnar-sided visualization
- MCR/MCU: Midcarpal portals for midcarpal joint access
- 1-2 portal: For volar wrist access
Procedure: Systematic examination of radiocarpal and midcarpal joints. Arthroscope provides magnified view on monitor. Instruments through working portals perform necessary procedures.
Common Arthroscopic Procedures
Debridement: Central tears (avascular zone) are shaved smooth. Quick recovery.
Repair: Peripheral tears sutured back to capsule or fovea. Longer recovery but restores stability.
Cyst and stalk visualized and excised from inside joint. Lower recurrence than aspiration. Smaller scar than open excision. Best for dorsal wrist ganglions.
SL ligament: Debridement of partial tears, assessment for reconstruction
LT ligament: Debridement, pinning
Thermal shrinkage: For mild ligament laxity (controversial)
Direct visualization of articular surface during reduction. Ensure step-off eliminated. Guide screw placement for scaphoid fractures. Assess ligament injuries associated with fractures.
Recovery Timeline
• Day 1-3: Soft dressing, elevate, ice
• Week 1: Sutures removed, begin gentle ROM
• Week 2-4: Progressive activity
• Week 4-6: Return to full activity
• Week 0-6: Cast or splint immobilization
• Week 6-8: Removable splint, gentle ROM
• Week 8-12: Progressive strengthening
• Month 3-4: Return to full activity
Advantages of Arthroscopic Recovery: Generally faster than equivalent open procedures. Less pain medication needed. Earlier return to desk work. Smaller scars with better cosmesis. Preserved grip strength.
Risks & Complications
- • Infection (<1%)
- • Nerve injury - usually sensory branches (1-2%)
- • Stiffness
- • Chronic regional pain syndrome (rare)
- • Compartment syndrome (very rare)
- • Recurrence (ganglions, TFCC tears)
- • Continued pain despite treatment
- • Need for further surgery
- • Tendon injury (rare)
- • Cartilage damage from instruments
Evidence & References
- • Slutsky DJ. Wrist arthroscopy portals and techniques. Hand Clin. 2011
- • Culp RW, et al. Complications of wrist arthroscopy. Hand Clin. 1999
- • Abe Y, et al. Outcomes of arthroscopic surgery for ulnar-sided wrist pain. J Hand Surg Am. 2017
- • Luchetti R, et al. Arthroscopic treatment of chronic wrist pain. Hand Clin. 2014
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)
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Dr. Deepthi Nandan Reddy
Senior Consultant Orthopaedic & Upper-Limb Surgeon | Apollo Hospitals
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