[The arthroscopic "wafer procedure" in degenerative disc ulnocarpal tears with ulnocarpal compression syndrome. Techniques, indications, results]

[Standard wrist arthroscopy: technique and documentation]

OBJECTIVE

Minimally invasive approach to the wrist in order to diagnose and treat different wrist pathologies.

INDICATIONS

Diagnosis of unclear chronic pain syndromes, cartilage status, intra-articular ligament structures as well as post-traumatic and inflammatory conditions of the wrist. Treatment of ulnar impaction syndrome, dorsal ganglia and also in fracture treatment and various different wrist interventions.

CONTRAINDICATIONS

Soft tissue infections around the wrist, severe scarring may impede access to the joint.

SURGICAL TECHNIQUE

Supine position with the forearm upright and in neutral position, the elbow flexed by 90°, axial traction of 3-4 kg. Superficial stab incision, blunt preparation through joint capsule, insertion of optic through 3-4 portal and probe through 4-5 portal, and radial and ulnar midcarpal portals, respectively. Either sodium chloride, CO2 or air is used as arthroscopy medium. Diagnostic round with standardized examination of all parts of the joint. Standardized written and high quality photo and/or video documentation to facilitate understandability of the findings.

POSTOPERATIVE MANAGEMENT

Forearm cast for 1 week, limited load for 2 more weeks, then load is increased to normal.

Ulnar Impaction Syndrome: Ulnar Shortening vs. Arthroscopic Wafer Procedure

The outcome of ulnar shortenings was compared with that of arthroscopic wafer resections for ulnar impaction (or abutment) syndrome in patients with a positive ulnar variance. The outcome was measured by DASH score, visual analog scale for pain, and working incapacity. The mean DASH score in the ulnar shortening group was 26; in the wafer group it was 36. The VAS scores were respectively 4.4 and 4.6. The working incapacity was 7?months in the ulnar shortening group and 6.1 months in the wafer group. The differences between the two groups were not statistically significant.

[Possibilities of wrist arthroscopy. Even for patients with arthritis?]

The wrist is the most commonly involved joint in rheumatoid arthritis (RA). Because it becomes involved early in the disease course and because this involvement rapidly progresses, early and adequate treatment is necessary to prevent disease progression. Arthroscopic synovectomy is recommended for pain relief and functional recovery in early-stage RA and is also helpful in advanced RA. The technique is complicated, and the learning curve is steep, but its efficiency is high. Arthroscopic synovectomy of the wrist reduces pain and improves function in most cases. It also improves motion, which is an advantage to the open procedure, and patient acceptance of this procedure is high. Nevertheless, arthroscopic synovectomy may delay the need for complex surgery, such as wrist arthrodesis or total wrist arthroplasty in selected cases.

[Indications and techniques for wrist arthroscopy]

After considering the anatomy of the wrist, the technical requirements for wrist arthroscopy are discussed. This method is used as an additional diagnostic procedure and staging procedure as well as a therapeutic technique. Complications, which are rare, most commonly involve nerve irritation, damage to cutaneous nerves and extensor tendons. Lose bodies can be removed arthroscopically, however, arthroscopically assisted fracture treatment or the removal of ganglions are uncommon. Approaches are lateral and oriented on the extensor tendons or other anatomical landmarks. Arthroscopy is especially useful by carpal instability as it offers many possibilities, not only diagnostically but also therapeutically.