Wrist arthroscopy allows examination inside the wrist joint. Sophisticated set of cameras and lighting provides direct visualisation of important joint structures, sometimes not visible and detectable by any other means/investigations. Naturally, this is an invasive procedure, so its benefits should be critically evaluated against the risks of intervention. Aims of arthroscopy are generally divided into two main groups:
Diagnostic arthroscopy – just inspect anatomy and exclude/diagnose the pathology so that further treatment can be planned. This is particularly helpful when exact grade of damage needs to be established or other investigations could not provide enough information (CT scan, bone scan, magnetic resonance imaging)
Therapeutic arthroscopy – treat the disease and/or repair damaged structures using special arthroscopic instruments (washout the joint, ‘clean’ inflamed joint lining, remove bone fragments and loose bodies, repair ligaments etc.)
For certain conditions it is possible to achieve both, exploration and treatment in the same arthroscopic setting.
The operation is usually performed on a day care basis under general anaesthetic, but it is also possible to numb the whole arm so that you stay awake (even watch television screen and the procedure if brave enough!).
During operation, hand is suspended vertically in order to distend the joint. Tight applicators are put onto the fingers so you might notice very temporary joint ache and skin creases after the surgery. Two to four small skin cuts are made in the wrist through which the camera and instruments are inserted into the joint. Care is taken not to injure the tendons and nerves just under the skin.
A simple look around takes about 30 minutes, but if other procedures are done at the same time it will take longer.
Saline is run into the joint to separate joint surfaces and improve visibility inside the joint. Keyhole wounds are closed with 1-2 sutures and wrist is bandaged for up to 1-2 weeks. If structures have been repaired at the same time, usually postoperative splint is required for few weeks, depending on exact procedure performed.
The patient is fit to go home soon after the operation. The anaesthetic wears off after approximately 6 hours. Simple analgesia 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 hand swelling. After surgery you can begin to practice finger exercises straight away. Your wounds may show some blood staining for the first 24 hours, this is quite normal and nothing to worry about. There may be some bruising which usually clears within two weeks. When/if the inner dressing falls off there is no need to replace it unless your clothes rub or catch on the wound. Dressing and bandage should be left in place for two days after the operation (make sure you keep it dry). You will then be able to remove the outer bandage but make sure you leave the inner sticky dressing in place for the first 7 days until it is wound is checked by the nurse, either in the hospital or at the GP practice. Any further treatment that the arthroscopy has identified will be discussed at the follow up visit in outpatients, usually 2 weeks after the surgery.
You need to take it easy and get plenty of rest when you get home for the first 2-3 days. You can start to do your usual activities, as you feel comfortable and are able to do so unless I advise you that postoperative plan indicates otherwise. When you return to work will depend on the work you do. Most patients return to work within two weeks but if your job involves physical activity of lifting it may be longer. Taking part in any strenuous activities and return to sport should be discussed at your follow up pending intraoperative findings. It is usually 4-6 weeks after the surgery.
For two days following a general anaesthetic you should not:
Drive a car or ride a motorbike, do not attempt to drive until you are in complete control of your hand. If you are unsure at all you should discuss this with your doctor. It is also advisable to check with your car insurance company, as some policies state that you must not drive for a specified period of time after an operation.
Risks and side effects of surgery:
Like with any other surgical intervention, complications following wrist arthroscopy are general i.e. associated to any hand surgery procedure and specific to wrist arthroscopy:
- Skin/wound infection
- Hypertrophic (lumpy and itchy) scarring
- Reflex Sympathetic Dystrophy – RSD (bad reaction to surgery with painful and stiff hands – this can occur with any hand surgery from a minor procedure to a complex reconstruction)
- Tendon injury (< 1%)
- Nerve injury
- Neuroma (painful nerve lump extremely sensitive to touch)
- Joint infection
Things to look out for
- Disproportionate swelling and pain in your hand
- Signs of infection in vicinity of the operated area i.e. hand/wrist are very hot, prominent redness, pain, swelling, puss collection
- Grazing of the skin (and possibly fluid leaking/oozing from the wounds)
- Increased temperature in the area
- Strange smells coming from the wounds.
If you notice any of above symptoms in the first few days, feel free to contact the team on numbers below.
This leaflet provides only basic and generic information, but full details and explanations are provided at the consultation as no two patients are the same and each person’s circumstances are highly individual.
If you have any concerns following your surgery please contact:
- Hospital where you were operated:
– Ashtead 01372 221 442; St Anthony’s 020 8337 6691; Parkside 020 8971 8000
- Your GP practice
- My secretary on 0845 026 7776 (Monday – Friday, 9.30 – 18.00)
|Hospital stay||Day care|
|Anaesthetic||General or Regional (the whole arm is numbed)|
|Surgery time||30-90 minutes|
|Wound healing||2 weeks|
|Splintage||not required unless ligament has been repaired|
|Hand therapy||usually not required|
|Washing||from week 2|
|Time off work||1-2 weeks for office based work; 3-4 weeks for manual work|
|Sports and exercise||from week 2|
|Driving||from week 1|
|Full recovery||2-3 weeks|