Other popular names
- Keyhole surgery
Why is it done?
If your consultant thinks you have a problem inside your wrist joint they may wish to look inside under direct vision with a camera. There are many reasons for us to wish to do this and include diagnosing ligament injuries, arthritis and cartilage damage/tears. There are an increasing number of treatments used with the arthroscope including trimming or repairing torn cartilage, removing loose bodies, removing inflamed lining of the joint and removing arthritic bone overgrowth.
An MRI scan can also show problems inside the wrist joint and is occasionally used as an alternative investigation
Surgery is performed as a day case procedure usually by putting under local anaesthetic. A simple look around takes about 15 minutes, but if other procedures need to be performed it can take longer. Approximately 3 or 4 small 3mm incisions are made on the back of the wrist to allow the camera and instruments inside. Care is taken not to injure the tendons and nerves just under the skin. After the arthroscopy the skin is sutured or fixed using steristrips and a bulky dressing is applied.
There are two main areas in the wrist that we view.
- radiocarpal joint
- midcarpal joint
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. The dressing should be removed after 2 days. The wound is cleaned and redressed with a simple dressing. The sutures (if any) are removed at about 10 days. Any further treatment that the arthroscopy has identified will be discussed.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving
The hand needs to have full control of the steering wheel and left hand the gear stick. It is advisable to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work
Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur. NB: The arthroscope is a disgnostic procedure and used to identify problems and does not itself cure any condition.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (2% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction.
- Injury to tendons as the arthroscopy is introduced (less than 1%)