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Arthroscopic Wrist Anatomy and Setup

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Wrist and Elbow Arthroscopy

Abstract

Wrist arthroscopy is a reasonable recently introduced technique but has continued to evolve rapidly. It has equipped the orthopedic surgeon with an excellent tool to assess and treat intra-articular pathologies with dedicated small optics and miniaturized instruments. Meticulous knowledge of the normal wrist anatomy is essential for performing wrist arthroscopy as well as palpation of the surface landmarks in relation to the portals that are to be established. That way important neurovascular structures are not jeopardized. While the classic (wet) wrist arthroscopy bears the disadvantage of cumbersome extra-articular water leakage into the soft tissue and the risk of serious complications as development of compartment syndrome the wrist joint can easily be inspected without the use of water, referred to as “dry arthroscopy”. The standard arthroscopic portals have been developed on the dorsal side of the wrist. With the more recent introduction of volar wrist portals it is now possible to have viewing and working portals that encircle the whole wrist joint. Wrist arthroscopy comprises the radiocarpal-, midcarpal-, and distal radioulnar joint. A standardized, systematic arthroscopic examination with a routine circuit helps in visualizing all structures and should be performed in each intervention. Once normal arthroscopic wrist anatomy is clear, pathologic problems can be identified and treated. This chapter includes video.

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Author information

Authors and Affiliations

  1. Hand Surgery and Surgery of Peripheral Nerves, University Hospital Bern, Freiburgstrasse, Bern, 3010, Switzerland

    Nicole Badur M.D.

  2. Private Activity, Rimini Hand & Rehabilitation Center, Via Pietro da Rimini 4, Rimini, 47924, Italy

    Riccardo Luchetti M.D.

  3. Fenice HSRT Hand Surgery and Rehabilitation Team, Centro di Medicina, Via Repubblica, 10/B Villorba, Treviso, 31050, Italy

    Andrea Atzei M.D.

  4. Policlinico San Giorgio, Via Gemelli 10, Pordenone, 33170, Italy

    Andrea Atzei M.D.

Authors
  1. Nicole Badur M.D.
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  2. Riccardo Luchetti M.D.
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  3. Andrea Atzei M.D.
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Corresponding author

Correspondence to Riccardo Luchetti M.D. .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, University of Mississippi, Jackson, Mississippi, USA

    William B. Geissler

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Arthroscopic tour of the radiocarpal joint from the 3-4 portal from radial to ulnar (MPG 7254 kb)

Arthroscopic controlled placement of the needle from the 3-4 portal for the establishment of the 6-R portal (MPG 2654 kb)

Arthroscopic controlled establishment of the 6-R portal. The capsule is pierced with the tip of a hemostat. A probe is inserted into the 6-R portal and the radiocarpal joint is palpated with the probe from ulnar to radial. On the ulnar side the TFCC is tested with the trampoline test and the Hook test. Towards the radial side the SL ligament is palpated (MPG 13338 kb)

Inspection of the ulnar side of the radiocarpal joint from the 6-R portal. The lunotriquetral ligament is visualized on the ulnar side (MPG 12298 kb)

With the camera in the 6-R portal the radiocarpal joint is inspected and palpated with a probe from the 3-4 portal. Note the dorsal distal attachment of the SL ligament to the capsule that separates the radiocarpal- and the midcarpal joint (MPG 10546 kb)

Inspection of the midcarpal joint through the MCR portal. With a probe in the MCU portal the lunotriquetral articulation on the ulnar side and the scapholunate articulation on the radial side are tested. Note the lunate type II according to Viegas with two separated facets, one for the hamate and one articulating with the capitate. On the radial side the arthroscope can be advanced into the STT joint (MPG 22700 kb)

Inspection of the midcarpal joint through the MCU portal. The scope cannot be advanced into the STT joint (MPG 3746 kb)

Inspection of the midcarpal joint from the MCU portal from radial to ulnar (MPG 11582 kb)

With the arthroscope in the MCU portal the MCR portal is established and the needle placement is controlled. With a probe in the MCR portal the scapholunate articulation is tested without any pathologic findings—the probe cannot be advanced into the physiologic cleft. Note the lunate type I with only one distal articulating facet for the capitate. On the ulnar side a fibro-fatty tissue is covering the gap of the lunotriquetral articulation (MPG 14326 kb)

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Badur, N., Luchetti, R., Atzei, A. (2015). Arthroscopic Wrist Anatomy and Setup. In: Geissler, W. (eds) Wrist and Elbow Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1596-1_1

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  • DOI: https://doi.org/10.1007/978-1-4614-1596-1_1

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