What is it?
This technique, also known as keyhole surgery, involves the insertion of a tiny telescope into the wrist joint. It’s an advanced diagnostic tool that allows direct visualisation and probing of joint surfaces, ligaments and other structures within the wrist. In combination with an MRI scan, it allows a comprehensive assessment of a troublesome wrist. Treatment for the problem can be undertaken at the same time with small instruments. This avoids large incisions and generally leads to quicker recovery times.
What is it?
How is it diagnosed?
Commonly performed procedures include: Triangular fibrocartilage complex (TFCC) tear debridement, Triangular fibrocartilage complex (TFCC) tear repair, Radial styloidectomy, Ganglionectomy, Synovectomy, Synovial biopsy, Limited wrist joint fusion, Treatment of dorsal impingement syndrome.
What is my approach to treatment?
What does an operation involve?
Surgery is normally carried out as a day case under a general anaesthetic. A tourniquet is applied to the upper limb. The wrist joint is distended by means of finger traps and counterweights. This allows insertion of a small telescope (2.7mm or 1.9mm) into the various joint spaces of the wrist. At the end of the procedure all incisions, between 2 and 6, are closed with steri-strips rather than sutures. A long acting local anaesthetic is then administered to provide pain relief. Finally, a dressing and bandaging are applied.
What is the recovery period?
This very much depends on the procedure being undertaken, and can be discussed at your first consultation. For TFCC shaving the following is typical: Once the local anaesthetic has worn off, normally 6 to 8 hours, simple analgesics and anti-inflammatory tablets may be used for pain. The hand should be kept elevated as much as possible during the first week after the operation, although finger movements are to be encouraged. A high-arm sling may be useful for this purpose. Bandaging is reduced at 7 to 10 days. Dressings and steristrips are removed in the clinic at two weeks. It should then be possible to wet the hand. Prior to this it’s possible to shower by keeping the extremity dry with a plastic bag secured over the limb using an elastic band or a purpose made shower cover. Most pain and swelling will have settled within four weeks after surgery. Driving is usually possible after seven days. When a patient is ready to return to work depends on their specific job role and may also vary from individual to individual. It may be possible to return to light keyboard work towards the end of the first week. Heavy manual work should be avoided for 3 to 4 weeks.
Are there any possible complications?
Over 90% of patients are satisfied with the result. However, as with any treatment, there are always risks involved: Infection: Less than 1%, Tendon injury: Less than 1%, Chronic regional pain syndrome: 2%, Sinus discharge: 1%
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