Minimally Invasive Surgery for the Hand and Wrist
When athletes lose their balance and fall during practice or competition, they often try to catch themselves with an outstretched hand. This can result in cartilage and ligament tears in the wrist or in wrist bone fractures. The injured athlete may be unable to return to his/her sport for a long period of time while he/she heals.
Wrist arthroscopy is one minimally invasive procedure that may hasten an injured athlete’s return to sports participation. Wrist arthroscopy is an outpatient surgical procedure that allows access to the joints in the wrist using several small incisions, a quarter of an inch in length (Figure 1), instead of the traditional long incisions. Through the arthroscope (Figure 2), the joint is visualized using a very small camera with an image projected onto a television monitor. In this way the joints, ligaments and cartilage structures can be evaluated as the wrist moves, facilitating diagnosis and treatment of complex problems without actually opening the joint. Athletes experience less post-operative pain, healing time is substantially lessened, and return to sports participation is hastened.
There is a cartilagineous, cushioning structure within the wrist joint that is amenable to arthroscopic treatment. Tears of this cartilagineous structure commonly occur after a fall on an outstretched hand, especially when accompanied by a twisting force. Pain (sometimes accompanied by a click) over the little finger side of the wrist aggravated by use, especially deviation of the wrist toward the little finger, is the most common symptom. Tears of the central portion of this cartilage disc are smoothed, and irritating flaps are removed. Those tears involving the periphery are repaired. Both treatments can be accomplished with arthroscopy.
The value of wrist arthroscopy as a minimally invasive means of diagnosis and treatment is clear. This technique enables the injured athlete to return more quickly to a higher level of sports participation. As technology progresses and smaller and smaller arthroscopes and instruments become available, indications for arthroscopy in the treatment of wrist injuries and even injuries involving the smaller joints in the hand will continue to broaden.
