Techniques in Wrist and Hand Arthroscopy

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Relevant anatomy and pathomechanics Isolated scaphotrapeziotrapezoidal (STT) osteoarthritis (OA) involves the distal scaphoid, trapezium, and trapezoid. The true incidence is uncertain because many patients with radiographic changes remain asymptomatic, but it is a common finding with advancing age. Bhatia et…

Biomechanics and anatomy One longitudinal radiographic study of 751 patients over a 24-year period showed that in those without osteoarthritis (OA) at baseline, women had more incidence of disease than men in almost all hand joints, but the joints most…

Rationale Arthroscopy of the first carpometacarpal (CMC) joint has become routine. The literature contains multiple reports of arthroscopic-guided reduction and percutaneous pin fixation of Bennett fractures involving the first CMC joint. The same techniques can be applied to fracture dislocations…

According to Edmonds, in 1882 Bennett first described a two-part intraarticular fracture at the base of the thumb metacarpal, which now bears his name. The Bennett fracture refers to an intraarticular fracture separating the volar-ulnar aspect of the metacarpal base…

The metacarpophalangeal (MCP) joint is ideally suited for arthroscopic evaluation. The MCP joint represents a single compartment, the bony and tendinous landmarks are easy to identify, and the neurovascular structures are remote from the portals; hence there is a short…

Biomechanics and kinematics A proximal row carpectomy (PRC) significantly alters the radiocarpal kinematics. Blankenhorn et al. found that following a PRC, wrist flexion and extension were accomplished by capitate rotation. In radioulnar deviation, capitate motion changed from predominantly midcarpal rotation…

Introduction The most common indications for a partial wrist fusion include scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns. Other conditions include Kienböck disease, radiocarpal joint arthrosis secondary to a malunited distal radius fracture (DRF), and scaphotrapeziotrapezoidal…

An arthroscopic resection of the distal scaphoid fragment can be regarded as a temporizing procedure for a chronic scaphoid waist nonunion or distal pole nonunion. It can relieve pain by alleviating the mechanical impingement between the hypertrophic distal pole and…

Pathophysiology An isolated tear of the scapholunate interosseous ligament (SLIL) changes carpal loading and kinematics even without demonstrable radiographic abnormalities. It can lead to attenuation of the secondary stabilizers and progressive dissociation and rotation of the scaphoid and the lunate.…