Hand surgery and wrist arthroscopy

Introduction of wrist arthroscopy in hand surgery:

Hand surgery and wrist surgery have improved significantly thanks to the development of specialized arthroscopy. Arthroscopic wrist surgery was born in the 1980s. The role of wrist arthroscopy was initially confined to the evaluation and exploration of lesions which were then repaired with traditional open surgery of the hand, hence the term “diagnostic wrist arthroscopy” used back then. It was only in the 1990s that wrist surgery made it possible to treat lesions and injuries using arthroscopy, without opening up: from then on, the term therapeutic wrist arthroscopy is used.

Instruments and techniques in hand and wrist arthroscopy

As with any technical breakthrough, arthroscopy originated from the scientific development of optical fibres, which were a major innovation for surgery, and hand surgery in particular. Wrist videosurgery operations were originally carried out using a 2.7 mm diameter camera (arthroscope), whose drawback is the size, a little too large for small wrists. Later, 1.9 mm arthroscopes were used, which were easier to handle and less traumatic.  I personally no longer use 2.7 mm arthroscopes in the wrist joint because I find them too large and think that they can damage the joint (cartilage) and ligaments of the wrist.

Very much like video techniques and arthroscopes evolved to meet the demands of hand and wrist surgery, first mechanical then electrical instruments (shaver surgical knives and burs, VAPR® hemostasis electrodes) have gradually got thinner to make arthroscopic repairs simpler in wrist and hand surgery

Arthroscope for hand and wrist surgery, 1.9 mm (top), 2.7 mm (bottom), Toulouse

 

Instruments for wrist and hand arthroscopy, grasping forceps and 2 mm shaver knives (below)

Advent of hand arthroscopy in hand surgery

Thanks to these smaller arthroscopes, arthroscopy was able to spread from wrist surgery to hand surgery. As a result, between the late 1990s to the early 2000s, arthroscopy became more popular for treating articular hand pathologies and injuries: metacarpophalangeal and trapeziometacarpal joints. Thus, arthroscopic surgery for rhizarthrosis appeared at the end of the 1990s (Menon J, Arthroscopy, 1996) and still constitutes a notable step forward for hand surgery. Similarly, arthroscopic hand surgery for metacarpophalangeal joints (sprain of the thumb and long fingers) began in the late 1990s.

Advent of endoscopy in hand surgery

Besides, these videosurgery techniques did not confine themselves to hand and wrist joints surgery. Indeed, arthroscopy has also contributed to extra-articular hand and wrist surgeryendoscopy is the term used in this instance. The most popular endoscopic hand surgery procedure is of course endoscopic carpal tunnel surgery. Popularized by Agee in 1992, this hand surgery technique has made the very frequent carpal tunnel procedures simpler and safer. This endoscopic carpal tunnel surgery technique has secondarily given birth to the endoscopic treatment of ulnar nerve entrapment at the elbow.

Benefit of arthroscopy in hand and wrist surgery:

Nowadays, arthroscopic surgery has multiple applications, in wrist surgery as well as in hand surgery:

In hand surgery:

  1. some fractures of the fingers and thumb can now be repaired with excellent accuracy thanks to arthroscopy, without any stitches. This arthroscopic hand surgery makes it possible to shorten convalescence but it also reduces adhesion and secondary stiffness.
  2. the carpal tunnel can be operated on endoscopically, without stitches and the resulting scar usually becomes invisible in time.
  3. rhizarthrosis or thumb osteoarthritis is the most frequent hand and wrist osteoarthritis, and it can in some instances be operated on arthroscopically by a specialized hand surgeon.
  4. serious thumb sprains can be operated on more anatomically with arthroscopy, by simplifying recovery after this hand surgery

In wrist surgery:

  1. wrist fractures, articular fractures of the lower extremity of the radius more specifically, can be checked, and sometimes even operated on arthroscopically. In these fractures, wrist arthroscopy makes it possible to evacuate hemarthrosis, to remove intra-articular cartilaginous debris, to check and optimize reduction and fixation, and of course to evaluate the lesions to the wrist's ligaments.
  2. scaphoid fractures can be operated on with greater accuracy and more solid results, with the camera allowing better monitoring and a safer procedure. The contribution of arthroscopy in the treatment of scaphoid fractures is such that some forms of scaphoid non-union can now be treated too.
  3. scaphoid pseudarthrosis (unmended scaphoid fracture or nonunion) can in some specific cases benefit from purely arthroscopic specialized wrist surgery.
  4. wrist sprains are more comprehensively diagnosed, with a more accurate surgical repair.
  5. synovial cysts of the wrist can be resected by arthroscopic surgery, which reduces scarring and shortens recovert.

After arthroscopic hand surgery, recovery is simpler and rehabilitation can start sooner for a quicker hand and wrist functional recovery.

 

Scar of wrist arthroscopy at 1 month