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16 Anatomic dissection of the wrist from dorso-radial ( a ), dorsal ( b ), dorso-ulnar ( c ), ulnar ( d ) and volar ( e ). ( 1 ) First compartment: containing the abductor pollicis longus (APL) tendon and the extensor pollicis brevis (EPB) tendon. ( 2 ) Second compartment: containing the extensor carpi radialis longus and-brevis (ECRL and ECRB) tendons. ( 3 ) Third compartment: containing the extensor pollicis longus (EPL) tendon. ( 4 ) Fourth compartment: containing the extensor digitorum communis (EDC) tendons and the extensor indicis proprius (EIP) tendon. ( 5 ) Fifth extensor compartment: containing the extensor digiti quinti (EDQ) tendon.
Source publication
Wrist arthroscopy is a reasonable recently introduced technique but has continued to evolve rapidly. It has equipped the orthopedic surgeon with an excellent tool to assess and treat intra-articular pathologies with dedicated small optics and miniaturized instruments. Meticulous knowledge of the normal wrist anatomy is essential for performing wris...
Citations
... In order to reduce the risk of damaging neurovascular structures around the wrist, the standard arthroscopic portals used are the dorsal portals. There are five radiocarpal, and two midcarpal arthroscopic portals which are generally accepted 21 (Table 2, Figure 4). The dorsal portals are based on the proximity to the six wrist extensor compartments. ...
Wrist arthroscopy has revolutionized the management of wrist pathology in recent years. This article aims to provide the reader with an overview of the procedure, its indications, set-up, and its applications, both diagnostic and therapeutic. Good knowledge of anatomy is a prerequisite to performing safe arthroscopic surgery and thus decrease iatrogenic complications.
... [8] Nevertheless, the benefits of arthroscopic wrist surgery were huge in comparison to open surgery, where arthrofibrosis can be a massive drawback. [9] The use of wrist arthroscopy has allowed us to understand the complexity of the anatomy of the TFCC. By 1996, an arthroscopic classification system of scapholunate (SL) ligament injuries emerged [10] and the complex anatomy of radial-sided ligamentous stabilizers was appreciated. ...
For a long time, wrist arthroscopy has languished behind that of shoulder and elbow arthroscopy. However, over the past two decades, there has been a steady increase in therapeutic wrist procedures undertaken using the arthroscope. While diagnostic wrist arthroscopy is still a useful tool, its therapeutic advantages are starting to stack up against the risks of open wrist surgery – mainly stiffness. It remains a technically demanding procedure, but is clearly in the armamentarium of orthopedic hand and wrist surgeons. Recent advances of dry arthroscopy, arthroscopic reduction and internal fixation, and arthroscopic fusion procedures have changed the face of minimally invasive wrist surgery. The new NanoScope™ along with wide-awake, local anesthetic, and no tourniquet techniques, means that we now can dynamically assess and treat wrist pathology without even encountering the risk of anesthesia. Wrist surgery is evolving, and arthroscopy is right at the forefront.
Triangular fibrocartilage complex (TFCC) tears are a frequent cause of ulnar-sided wrist pain, and our understanding of these injuries has evolved significantly over the past few decades. As we have come to better understand these complex injuries, the indications for surgery have been refined and classifications have been created to delineate what specific types of pathology are clinically relevant to the surgeon. Similarly, surgical treatment methods have evolved as well. TFCC repairs were initially performed open, but there has been a shift toward performing these repairs arthroscopically. Moreover, there is a plethora of literature describing different techniques for arthroscopic repair. In this chapter, we describe an arthroscopic technique for transosseous repair of peripheral TFCC repairs to the ulnar foveal through an ulnar bone tunnel. It is our belief that this technique is a relatively straightforward and reproducible way to anatomically reduce the TFCC to its footprint on the ulnar fovea and thus restore stability to the distal radioulnar joint (DRUJ). In addition to background information about the diagnosis of and clinical treatment guidelines for TFCC tears, this chapter describes in detail our technique for performing an arthroscopic peripheral TFCC repair through an ulnar bone tunnel.
Secondary wrist stiffness usually occurs following trauma or surgery and is classified as intra-articular, capsular, or extra-articular. Arthrofibrosis affects the radiocarpal, midcarpal, ulnocarpal, and/or distal radioulnar joints. Conservative treatment is the mainstay of management. Once conservative modalities fail, surgical arthrolysis, either open or arthroscopic, helps to relieve pain and restore motion. Arthroscopic arthrolysis involves resection of intra-articular adhesions, chondral debridement, capsulotomy, and release of radiocarpal ligaments. Arthroscopy will often reveal other occult pathologies which can be treated during the same procedure if appropriate. Rehabilitation should be started immediately after surgery and individualized to the pathologies and requirements of the patient. Arthroscopic arthrolysis is the surgical treatment of choice as it is less invasive, allows immediate postoperative mobilization with minimal scarring.
Purpose
To evaluate the accuracy of the Trampoline and Hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared to arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ).
Methods
135 patients (97 males, 38 females, mean age 43.5 years) were divided into 2 groups: A) 80 patients with chronic ulnar sided wrist pain and positive fovea sign and B) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy, by Trampoline and Hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity and likelihood ratio of the two diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference.
Results
The Trampoline and the Hook test showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the Trampoline test was similar for distal (69%), proximal (66%) and complete (73%) TFCC tears. The Hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for Trampoline and Hook tests was 75.00% and 0.00% (p<0.001) for distal tears, and 78.85% and 100.00% (p<0.001), and 58.33% and 100.00% (p<0.001), for complete or isolated proximal tears, respectively. Specificity for Trampoline and Hook tests was 67.27% and 96.36% (p<0.001) respectively.
Conclusions
Trampoline and Hook tests can assure accurate diagnosis of peripheral TFCC tear. The Hook test shows higher specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a higher probability to detect foveal laceration of peripheral TFCC for the Hook test than for the Trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal detachment of the TFCC, if the Hook test is positive.
Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient’s work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. Results: At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest ( P = .001), under maximal load ( P = .0001), and in Mayo Wrist Score (MWS) ( P = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (–10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the “critical” 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Conclusions: Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.
