Wrist Arthroscopy

Abstract

The use of wrist arthroscopy in the pediatric population is not as common as in the adult population, partly because the majority of pediatric wrist complaints are treated nonoperatively. The majority of wrist complaints in the pediatric population are acute and traumatic in nature. In the absence of radiographic evidence of fracture or physeal injuries following trauma, soft-tissue injuries should be considered. Chronic wrist pain often results from prior injury, structural malformation (e.g., Madelung’s deformity), or systemic disorders (e.g., juvenile rheumatoid arthritis). A short period of immobilization followed by directed physical therapy (if necessary) is typically the initial treatment of choice. However, patients who fail conservative treatment options should be evaluated further for other possible underlying causes of disability and pain.

With this chapter, one should be able to outline the history and physical examination findings that may warrant the use of appropriate diagnostic studies and, potentially, operative management with wrist arthroscopy in the pediatric population. Surgical protocols are very similar to those seen in the adult population. Common pathologies found in adults such as triangular fibrocartilage complex (TFCC) tears, scapholunate interosseous ligament (SLIL) tears, or lunotriquetral interosseous ligament (LTIL) tears are also among the most common pathologies seen in the pediatric population as well. Special considerations for wrist arthroscopy in pediatric patients mainly involve structural abnormalities with aberrant anatomy, the smaller overall size of the joint spaces, and ligamentous laxity in physiologically immature children. The existing literature suggests that wrist arthroscopy is a safe treatment strategy in pediatric patients with wrist complaints who fail conservative treatment.