Author: I. Chakrabarti with additional material by A. Kocheta
The wrist is a complex structure made up of several bones which are covered by cartilage and connected to each other by many ligaments (figure 1). Two of these (shown in red) are quite commonly damaged. There is also a tough, complicated structure called the “Triangular Fibro-Cartilage Complex” which is in many ways similar to the so-called cartilage (or “meniscus”) of the knee.
WHAT IS WRIST ARTHROSCOPY?
Wrist arthroscopy is a form of “keyhole” surgery that involves inserting into the wrist an instrument (a “wrist scope”) connected to a camera. This is done through a small incision. Other instruments are also inserted in a similar way to allow procedures to be performed. This includes inspection of the bones, ligaments and other parts of the wrist joint. It is sometimes possible to repair certain ligaments or remove damaged and torn tissues without having to make the incisions bigger.
How is it done?
You are given a General Anaesthetic (put to sleep for a while) or a Regional Block, where local anaesthetic is injected to numb the arm whilst staying awake. The technique to be used is decided after discussion between you, your anaesthetist and your surgeon.
A tourniquet (a tight cuff to cut off the circulation to the arm) may be used for the duration of the operation. Following this, “Chinese finger traps” are applied and the arm is suspended using a traction device to allow more room for the instruments to be inserted (figure 2); in most cases (though not all) four small, 3-4mm, incisions are made on the back of the wrist joint, allowing the surgeon to inspect and treat the different parts of the wrist joint.
Wrist arthroscopy is often done as a day-case procedure, meaning that you do not have to stay in hospital overnight. However, certain procedures or long-standing medical problems may require an overnight admission. The details in your specific case will be discussed with you by your surgeon and anaesthetist.
After the Operation
A bandage or a splint is applied depending on the surgeon’s recommendation and the exact type of procedure you have had. It is important to keep the hand elevated and move your fingers as much as possible to avoid swelling and stiffness. Painkillers such as Paracetamol, codeine, anti-inflammatory tablets – or a combination of these – are prescribed.
Depending on the findings and the procedure performed at the time of surgery, your surgeon will advise you on whether you should move the wrist and whether you need Physiotherapy and/or Hand Therapy.
After 10-14 days, you may need to have some stitches removed either at the GP practice or at the hospital. The scars (which are small and often not noticeable) will be tender and sensitive at first – it is important to massage them as much as possible. A non-perfumed skin moisturiser (such as E45) can be used. Massage the scars firmly when they have healed and for one inch (25mm) all around. Do this for 1-2 minutes 3-4 times a day. This may be uncomfortable to start with but persevere as this will reduce the swelling and tenderness faster than leaving it alone.
Risks of Surgery
Infection. This is rare: less than one in a hundred cases. However, if it should occur, it is usually treated successfully with antibiotics.
Nerve damage. This also uncommon. Small nerves around the operation site can be stretched and bruised; if so, you may have a numb patch over the back of the hand. This usually settles by itself but may take a few weeks. It is unlikely to be permanent.
Scar tenderness/sensitivity. The scars are often tender and sensitive at first. However, they usually settle with skin massage.
Stiffness. There may be some stiffness of the wrist to start with, but this nearly always settles.
Tendon damage. Very rarely, in less than one-in-a-thousand cases, one or more of the tendons (“guiders”) of the fingers may be damaged. If so, it is nearly always possible to repair them and regain normal use of the finger or fingers involved.
There may be other specific risks associated with the specific procedure you are having. Your surgeon will discuss these with you before the operation.
Do not forget that you will not be able to use the hand that has been operated on fully for a short while after surgery. Make life easy for yourself at home by planning ahead, particularly if you are alone at home or if you will be alone at home for long periods in the day. Get enough shopping in to last for a week or two after your surgery, as you will not be able to drive. Loosen the tight caps of jars (but don’t forget the contents will go off more quickly). Ready-meals might be useful for a few days after surgery or do some cooking before and freeze it. Wear slip-on shoes so you don’t have to tie laces etc.