- Positioning and Preparation:
- joint is distended w/ finger traps (to index and long fingers) w/ about 10 lbs, using a pulley system;
- counter traction is applied to the arm w/ use of a second 10 lb pulley - this allows the elbow to be flexed 90 deg;
- gravity assistant inflow;
- initially inject about 6 cm of lidocaine w/ epinephrine to distend the capsule;
- 2.7 mm or 3 mm wrist scope;
- wrap out the forearm with carefully applied sterile Coband which will help prevent extravasation of fluid from the frx site into the forearm;
- don't forget to mark out the dorsal wrist veins before wraping out and elevating the tourniquet;
- if the veins are transected, a larger portal skin incision will be needed to achieve hemostasis;
- Wrist Portals:
- distraction is not always required for routine wrist arthroscopy;
- in the report by Huracek and Troeger (2000), the authors describe a technique for arthroscopy of wrist which is carried out without traction and with the arm lying horizontally on the operating table;
- wrist is not immobilised, which makes it possible to assess the extent of instability after a ligamentous tear;
- advantages were that the horizontal position of the arm allows the surgeon to proceed directly from arthroscopic diagnosis to treatment, and that no change of position is required for fluoroscopy;
- Wrist arthroscopy without distraction. A technique to visualize instability of the wrist after a ligamentous tear.
- outflow cannula:
- use 14 gauge angiocath;
- placed just ulnar to ECU (6U portal);
- note the proximity of the dorsal ulnar cutaneous branch;
- some surgeons will use this as an outflow portal;
- arthroscopic portal:
- 3-4 portal: (between ECRL and EPL)
- lies 1 cm distal to the Lister's tubercle;
- insert the scope in line with the dorsal radial slope;
- instrumentation portal:
- 4-5 portal: (between EDC and EDQ)
- the arthroscope may be inserted thru this portal inorder to visualize a TFCC tear;
- mid-carpal portal:
- lies in the scaphocapitate interval;
- inserted radial to the third ray, distal to the proximal row, just radial to the EDC to the index finger;
- 1-2 wrist portal:
- may serve as the the inflow cannula;
- lies in the 1-2 wrist portal (between the ECRB and the APL;
- note that the radial artery courses along the volar aspect of this interval;
- the portal should be inserted near the proximal and dorsal portion of the snuff box adjacent to EPL and the ECRL, in order to avoid artery
Techniques of wrist arthroscopy.
Precautions for arthroscopy of the wrist.
Complete avulsion of the distal posterior interosseous nerve during wrist arthroscopy: a possible cause of persistent pain after arthroscopy.
Arthroscopic portals of the wrist: An anatomic study.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, December 12, 2012 3:09 pm