[Orthopedic Arthroscopy] Wrist Arthroscopy

Arthroscopic surgery involves inserting a lenticule-equipped metal tube with illumination through a small incision into the joint cavity. The internal structure of the joint cavity is magnified on a monitor, allowing observation of lesions and their locations. Simultaneously, a comprehensive examination and cleaning of the affected area is performed under video monitoring. Arthroscopic surgery is a minimally invasive procedure that serves both diagnostic and therapeutic functions.

Preoperative Preparation

1. Understand the patient's psychological reaction, strengthen nursing care, help the patient understand the surgical procedure and its significance, build confidence, and cooperate with the surgery.

2. Obtain a detailed medical history, noting any history of drug allergies.

3. Discontinue anticoagulants before surgery.

4. Keep the skin of the surgical joint clean, avoiding any abrasions, burns, cuts, scratches, infections, or other injuries to the surgical joint area.

5. Perform isometric contraction exercises of the quadriceps femoris muscle one day before surgery.

6. Administer prophylactic antibiotics 0.5–2 hours before surgery.

Surgical Introduction

Wrist joint surgery requires the use of a "Chinese finger cot" or traction board to widen the wrist joint space, facilitating the entry of the camera and surgical instruments into the joint cavity.

The wrist joint camera and instruments are very miniature to fit the narrow joint space, with the camera diameter being approximately 2mm.

In most cases, the wrist arthroscopy enters the wrist joint cavity from the dorsal side. The dorsal side of the wrist joint contains numerous tendons, which are divided into six groups based on their anatomical location. The surgical approach is established between these tendon groups; for example, the approach between tendons group 3 and 4 is called the 3-4 approach, which is the most commonly used channel for the endoscope.

Arthroscopy and manipulation instruments are inserted into the wrist joint cavity to examine and diagnose the entire joint and to perform related treatments.

Initially used only for observation, wrist arthroscopy was first applied to disease diagnosis over a decade later, though it wasn't used for complex treatments at that time. Today, wrist arthroscopy can diagnose and treat a wide range of wrist conditions, such as TFCC (triangular fossa contusion), cartilage damage, ligament injuries, ganglion cysts, scaphoid fractures, nonunion fractures, and as an adjunct treatment for distal radius fractures. Some procedures require small incisions to facilitate the operation.

"This surgery is minimally invasive, has a fast recovery time, and leaves minimal scarring. Furthermore, the medical team will tailor a treatment plan to each patient's specific situation to ensure optimal surgical results."

7. Postoperative Care

1. Observe the wound for bleeding and oozing, limb swelling and pain. Check the dorsalis pedis pulse. Prevent circulatory obstruction caused by overly tight bandages. Check for frostbite when applying ice.

2. Elevate the affected limb postoperatively to reduce swelling. Keep the joint warm.

3. Perform isometric contraction exercises of the quadriceps femoris muscle on the first day after surgery to promote blood circulation and reduce swelling.

4. Continue functional exercises after discharge until the joint range of motion is normal, pain disappears, and walking is normal.

5. If the incision is red, swollen, painful, or oozing, seek medical attention immediately.

Totally arthroscopic TFCC repair has significant advantages such as minimal trauma and rapid recovery. Especially for women who value aesthetics, it generally leaves no significant scarring on the wrist. Furthermore, the arthroscopic technique allows doctors to perform a comprehensive examination of the wrist joint, addressing any potential concurrent injuries. Its clinical application is becoming increasingly widespread and is welcomed by many patients.