Arthroscopy of the hand joint(s)

Arthroscopy is the introduction of optical and surgical instruments and light in the body joints for diagnostic and/or therapeutic manipulations using small incisions – portals. Hand arthroscopy is used to examine and treat traumatic damage to ligaments and bones, changes to bone and cartilage caused by arthritis or arthroses, as well as to diagnose possible causes of various forms of unclear pain directly in hand joints.

From a technical point of view, hand arthroscopy is more complicated than the arthroscopy of the knee or shoulder joint, because many tendons, nerves and blood vessels located on all sides of the hand joint must be avoided. There is a specific portal map which marks the relatively safe places for the introduction of the optic and instruments in the joint cavity. These surgeries are performed with hand joint arthroscopes of 2.4 mm diameter and manipulation instruments of corresponding size. For the arthroscopy of finger basal joints, optics with a diameter of 2.0 mm are used, and correspondingly, even smaller instruments for manipulations. The hand is fixed in a specific distractor – in the hand arthroscopy tower; during the surgery an arterial tourniquet is applied.    

Arthroscopies of the hand joint are divided into diagnostic and therapeutic groups. During diagnostic arthroscopy damage to the hand and finger joint ligaments can be evaluated, as well as the condition of the triangular fibro-cartilage complex (TFCC) and possible damage, quality of the joint cartilage, as well as causes of chronic hand pain of unclear etiology. If proper diagnosis is performed, during the same surgery, removal of TFCC lesions can be performed with the resection of the affected cartilage part, or suturing without opening the joint can be performed. During the therapeutic manipulation, a synovectomy can also be performed, as well as the removal of free bodies, resection of the affected bone part, division of scarring occurring following injuries or the visualisation of bone fractures during osteosynthesis or arthrodesis surgeries.

If “dry surgery techniques” are applied, which is globally, a relatively new method, the postoperative swelling is minimal and the risk of compression of the nerve channel at the level of the wrist is reduced.

Duration of the surgery: on average 30 min to 1.5 hours.

Anaesthesia: regional or general.

Treatment: in an out-patient setting or 1 day in the hospital.

Convalescence: following surgery local discomfort and pain may occur, which is well controlled with analgesic tablets. The wounds heal in approximately 10 days. During the postoperative period, a plaster cast is sometimes necessary and the dressings shall be changed 2 to 3 times a week. In isolated cases, ergotherapy and movement training for the fingers and/or wrist joint may be necessary.

Result: the treatment results depend on the type of lesion diagnosed and the start of the treatment in due time. For problems discovered during diagnostic arthroscopies, second stage surgery may be necessary if the damage cannot be prevented during the first surgery.

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