What is Arthroscopic Wrist Surgery and Do I Need it?
Advances have been made in minimally invasive procedures and your orthopedic surgeon may deem you a good candidate for arthroscopic wrist surgery. A small incision allows your doctor to view inside your wrist without needed to make a larger incision. If you have suffered and injury to your wrist you should contact an orthopedic surgeon in your area.
Who Needs Arthroscopic Wrist Surgery?
If you have suffered from an injury, or have a condition that’s causing your wrist to swell or experience pain, you may benefit from arthroscopic wrist surgery. The good news is that here at Regional Orthopedics, you can have the procedure done in New York City, Staten Island or Jersey City.
Arthroscopic wrist surgery is quite common. Over the past five years, the wrist has been the third most common joint that arthroscopy was performed on. The first two were the shoulder and knee. In 2015, there were over 76,000 nonfatal work-related wrist injuries that involved 14 days of missed work, according to the Bureau of Labor Statistics.
A wrist surgeon in Staten Island, NY performs this procedure after you have sustained an injury to your wrist, by either falling on it or twisting it, and are experiencing swelling, pain and clicking noises. It’s important to first consult with your primary care doctor to determine if you need to see a wrist surgeon in New York City to undergo arthroscopic wrist surgery.
Arthroscopic Wrist Surgery: How It’s Done
An arthroscopic wrist surgeon in Staten Island, NY performs the surgery by using surgical tools and a tiny camera to look at and repair your wrist and the tissues inside. This tiny camera is referred to as an arthroscope.
The surgeon detects problems during the procedure so that he or she can make repairs to your wrist without having to make large cuts into your tissue and skin. This allows you to recover quicker after surgery, while experiencing less pain.
A wrist surgeon in NYC is able to see your bone cartilage surfaces and ligaments during a wrist arthroscopy procedure. While some ligament parts might not heal properly because they don’t have enough blood supply and therefore need to be removed, most do and can be repaired and then go on to heal properly.
As more surgeons are exposed to and perform wrist arthroscopy, newer instrumentation is developed and improved techniques continue to emerge.
Anatomy of the Wrist
Your wrist is a very complex joint. It consists of a number of articular surfaces with intrinsic and extrinsic ligaments, a triangular fibrocartilage complex (TFCC) and eight carpal bones, all within an interval of five centimeters.
When performing wrist arthroscopy, a wrist surgeon in Jersey City, NJ can visualize synovial tissue, ligaments and cartilage directly, using magnification and bright illumination.
You have two bones in your forearm. These are:
- Your ulna (the small bone on the pinky side of your arm)
- Your radius (the large bone on the thumb side of your arm)
Your wrist forms where these two bones meet the carpus. Your wrist consists of a number of joints where your hand and the bones of your arm connect, which allows movement. In addition, there are two groups your carpal bones are organized into — a distal row and a proximal row.
Your distal row consists of the:
- Trapezium
- Trapezoid
- Capitate
- Hamate
Your proximal row consists of the:
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
Your distal row hinges with your five metacarpal bones at their bases, while your proximal carpal row is located where your distal wrist creases. Your proximal carpal row bones are considered to be an intercalated section, since none of your tendons insert upon them. Because of this, they move with your surrounding articulations’ mechanical forces.
Your distal row of bones supports each other closely through your intercarpal ligaments. They are additionally bound to your metacarpal bones tightly, and represent your carpometacarpal (CMC) joint. Specifically, your capitate and trapezoid are bound to your middle (third) finger and index (second) finger metacarpals. Your ligamentous connections are so stiff, your distal carpal row has been thought to be an element of a fixed hand system, where the musculotendinous forces of your forearm move it.
A fibrous capsule surrounds your wrist joints, which are held together by multiple ligaments that offer stability to the carpal by connecting your bones both volarly and dorsally.
Your carpal ligaments are broken down into two groups:
- Extrinsic ligaments (these bridge your carpal bones to your metacarpals or radius)
- Intrinsic ligaments (these insert on your carpal bones)
Reasons for Arthroscopic Wrist Surgery
As you can see, your wrist is quite complex, and now that you know its anatomy, let’s move on to the reasons why you would have arthroscopic wrist surgery performed.
As with any orthopedic condition, you have a number of surgical and conservative treatment options. Typically, people who have wrist pain or wrist injuries tend to respond well to OTC pain relievers, physical therapy and other conservative treatments. But, if you try these and don’t respond to them, an effective way to evaluate and treat your wrist condition and pain is through wrist arthroscopy.
If the arthroscopic wrist surgeon in New York City is unable to determine what’s causing the pain in your wrist, they may perform diagnostic arthroscopy. Additionally, they may perform this procedure if you have already tried various non-surgical treatments and you’re still experiencing wrist pain after several months.
The arthroscopic wrist surgeon in NYC may perform this surgery to treat a variety of wrist conditions, including:
Triangular Fibrocartilage (TFCC) Tears
The TFCC is a structure found in your wrist that’s very important. It can easily get damaged if you overuse your wrist or suffer a wrist injury. If you don’t respond to conservative treatments and physiotherapy, the surgeon can use the arthroscope to assess how much damage you have and repair any tears, remove cartilage or perform other necessary tasks. All this depends on how old the tear is and if it’s repairable at all.
Osteoarthritis of the Wrist
When you have worn cartilage in one or more of your wrist joints, it’s referred to as osteoarthritis of the wrist. Wrist osteoarthritis is characterized by stiffness and pain in your wrist. The goal of having surgery done to your wrist is to reduce this pain while maintaining maximum mobility.
Wrist osteoarthritis can be very painful to the point where it incapacitates you and your ability to hold or grip objects and perform reflex movements. Typically, in cases of osteoarthritis of the wrist, reduced range in joints and wrist stiffness are usually found.
There are three types of wrist osteoarthritis, which include:
- Degenerative wrist osteoarthritis
- Post-traumatic wrist arthritis
- Rheumatoid osteoarthritis
The surgeon will perform an x-ray analysis, including an MR or CT arthrography of your wrist to confirm if you have osteoarthritis of the wrist and how much wear you have on the joints, as well as if you have any ligament lesions that could be associated.
Following your radiographic and clinical examination, the surgeon determines the appropriate wrist surgery for wrist osteoarthritis.
Chronic Wrist Pain
An arthroscopic wrist surgeon in Jersey City, NJ might perform exploratory arthroscopic surgery to diagnose any chronic wrist pain you have if other tests couldn’t provide him with a clear diagnosis. Following a wrist injury, there are often areas of cartilage damage, inflammation and other findings that could be missed, which exploratory arthroscopic surgery can help reveal and repair.
Wrist Fractures
After a fracture, there could be small bone fragments that remain in your joint. These fragments can be removed during wrist arthroscopy and the surgeon can also align any bone pieces that are broken and stabilize them with wires, pins or screws.
Ganglion Cysts
These cysts often grow between your two wrist bones from a stalk. The surgeon can remove this stalk during an arthroscopic surgery, which can help decrease the change these types of cysts can bring about.
Ligament/TFCC Tears
Your ligaments hinge or link your bones and are fibrous bands of connective tissue. They support your joints and offer stability to them. Inside your wrist, you have the TFCC, which is a cushioning structure. You can tear the TFCC, ligaments or both by falling on your outstretched hand. This can be very painful — however, you can have these tears repaired through arthroscopic surgery.
Carpal Tunnel Release
When you have tingling or numbness in your wrist and hand that causes pain up your arm, this often indicates carpal tunnel syndrome. This is due to nerve pressure that goes through your carpal tunnel. This pressure often builds up inside the tunnel for a number of reasons, which include tissue swelling and irritation that covers your tendons.
If non-surgical treatment doesn’t repair this carpal tunnel syndrome, another common treatment would be arthroscopic surgical repair of this area. Your surgeon would enlarge your tunnel and cut the ligament roof. By doing this, he releases the nerve pressure, which in turn relieves your symptoms.
Carpal Instability
You can sometimes tear your wrist ligaments by falling on your wrist or experiencing other types of wrist injuries. In some cases, the surgeon might not be able to see if you need a repair by scans alone, and would therefore perform wrist arthroscopy to assess how much damage you have and see if a repair is needed. Once he finds the ligament injury, he may recommend surgical treatment.
Cartilage Damage or Wrist Synovitis/Arthritis
You may experience wrist joint irritation or degeneration due to a number of conditions which can lead to swelling, pain and loss of function. The surgeon would perform arthroscopic removal of loose cartilage pieces, irritated tissue and, in some cases, bone spurs, which are located in your wrist joints. This can help reduce your swelling and pain and improve motion.
The surgeon can smoothen or shave off the worn area if you’re experiencing cartilage (arthritis) wear. He would then remove any cartilage or bone fragments that have chipped off your joint, producing a pain-free and smooth movement. However, if your arthritis is part of rheumatoid arthritis or another general disease, he might not be able to stop it from progressing.
Ulna-Impaction Syndrome
If you have an ulna-impaction that’s caused by minor increasing in your ulnar length, your surgeon can perform arthroscopic removal or shaving of the bone or cartilage to stop the infringement it has on your wrist, which helps you to move and rotate your wrist without experiencing any pain.
Wrist arthroscopy is minimally invasive and doesn’t produce as much pain as regular surgery, making it a good option for restoring the function of your wrist. It can make tasks that you were challenged with before surgery become less painful and easier after recovery. There are a number of benefits of arthroscopic surgery when compared with regular surgery, which include:
- Less trauma to your muscles, tissues and ligaments
- Lower infection rate and less scarring, due to smaller surgical incisions
- Quicker recovery time and less pain
- Faster mobilization after surgery
- Outpatient stay or a shorter hospital stay
These are just some of the many benefits of this surgery.
Risks From Arthroscopic Wrist Surgery
Arthroscopic wrist surgery has been shown to be effective and safe for various wrist and hand conditions. This doesn’t mean there are no risks involved, however. There’s still the possibility of blood vessel or nerve injury.
The best way to reduce your risks and have a successful outcome is to ensure the wrist surgeon in Staten Island, NY is experienced in wrist surgery and has the specialized training required to perform the job.
Risks from arthroscopic wrist surgery or anesthesia may involve:
- Breathing problems
- Allergic reactions to medications
- Blood clotting, infection or bleeding
- Wrist weakness
- Failed repair and healing
- Damaged cartilage, tendons or nerves
- Loss or stiffness of joint motion
Rehabilitation can address stiffness after your surgery. Although risks like these don’t happen that often, they’re still there.
In order to determine the nature and incidence of complications following an arthroscopic wrist procedure, researchers conducted a wrist joint study. During this study, the surgical and outpatient reports of 211 patients that had wrist surgery performed were reviewed in order to determine what procedure was performed, what anesthetic type was used, which portals were used and if there were any post-surgical complications and if so, what type.
Researchers found that out of the 211 patients, about five percent (11) of the patients experienced complications. Around four percent were minor complications and only .9 percent were major. Of these, five complications were found immediately following surgery and six were delayed. With conservative care, all the minor complications had been resolved by the latest follow-up examination.
The chances of a complication happening can be lowered with a good surgeon who has the right skills and experience. You can also reduce your chances of complications by following all instructions given to you by the surgeon following surgery on how to properly care for your wrist and the area that was treated.
What Happens Before Wrist Surgery?
Before your surgery, you’ll sit down with your surgeon for a consultation, where he’ll go over the history of your condition or problem and examine your wrist. It’s important that you’re thorough when discussing the problem you’re experiencing, including the limitation or severity, in order for the surgeon to come up with a proper diagnosis.
In addition to examining your wrist, your surgeon may also perform other tests to help confirm the diagnosis, including taking laboratory tests, x-rays, MRI scans, CT scans and bone scans. These tests will also help him determine the proper treatment for your individual case.
Although arthroscopy wrist surgery could repair your problem completely and enable you to recover quicker, the surgeon may need to look inside your wrist using a diagnostic arthroscopy procedure to confirm diagnosis. He can then plan on additional surgeries if needed or treat the problem, depending on what he finds.
It’s important that you tell the surgeon about all of the medications you’re currently taking, including herbs or supplements that you take without a prescription.
During the first couple of weeks before your scheduled procedure:
- Your surgeon might ask you to stop taking medications like naproxen (Aleve, Naprosyn), ibuprofen (Motrin, Advil), aspirin or other medications that make blood clotting more difficult.
- You should ask the surgeon if there are any medications you should take the day of your procedure.
- Your surgeon may have to consult with your doctor who treats you if you have heart disease, diabetes or other medical conditions.
- You should tell your surgeon if you smoke or drink alcohol. Smoking can slow down bone and wound healing.
- You should tell your surgeon if you have or had the flu, cold, a herpes breakout or other illnesses before your procedure.
Your surgeon will go over all details with you during your consultation before your surgery, what you can expect and what he needs to know.
What Happens During Wrist Surgery?
Typically, you’ll be asked to stop drinking and eating for a certain time period before your surgery. Be sure to follow all of these instructions precisely.
Generally, arthroscopic wrist surgery is performed using regional anesthesia in an outpatient facility. This anesthesia is used to numb your arm and hand so you won’t feel any pain or discomfort during the surgery.
The surgeon will use an arthroscope so he can gain access to your wrist joints after he has made a few small incisions. He then uses the small camera to visualize your joints. This camera projects the image onto a computer or television monitor. Your surgeon then can use the arthroscope to detect damaged tissues or to repair your ligaments, joints and cartilage structures.
He then closes up your incisions with small stitches once he’s completed surgery and applies a dressing. In some cases, he may apply a splint to promote healing and to stabilize your joint. The entire procedure typically takes around an hour, but may vary depending on the type and severity of your condition.
What Happens After Wrist Surgery?
After your surgery, you should be able to go home after you’ve rested in a recovery room for a couple of hours. Someone should pick you up and drive you home. You’ll need to elevate your wrist above your heart for a few days to reduce the pain and swelling. You may also use a cold pack to reduce swelling.
Follow your doctor’s instructions on how to care for your wrist and change the dressing. If your doctor tells you it’s safe, you may take pain relievers if needed. As your post-surgery pain starts going away, you’ll be able to slowly return to your normal activities.
Your recovery could take anywhere from a few days to several months, depending on the condition or injury you had treated.
The doctor might put you on the RICE regimen following your surgery for the first few days. The RICE regimen consists of:
- Rest
- Ice
- Compression
- Elevation
Avoid taking a shower until your dressing is either replaced with a waterproof covering or removed completely.
You’ll likely be asked to avoid any activities that use your wrist, such as pulling, lifting, twisting or pushing. When compared with regular surgery, since arthroscopy involves smaller incisions in your skin, you’ll likely experience:
- A faster recovery
- Less stiffness and pain during your recovery
- Fewer complications
These small incisions should heal fairly quickly so you can get back to your normal activities in just a short couple of days. However, if you had a lot of wrist tissue repaired, you might have to wait a few weeks before attempting your normal routine, to give it time to heal. Your doctor may refer you to a physical therapist to assist you in getting the full function of your wrist back.
Talk to Us About Arthroscopic Wrist Surgery
Here at iOrtho The Orthopedic Institute, we’ve been offering our New York City, Staten Island and Jersey City patients joint pain treatment since 1999. To learn more about your treatment options for your wrist injury or condition, contact us at any of the following numbers:
- 718-477-5479 (Staten Island)
- 212-431-1200 (Manhattan)
- 212-598-6000 (NYU HJD)
- 212- 254-3570 (Gramercy Surgery Center)
- 732-525-2227 (New Jersey)
