TFCC tears

SL instability

Dorsal wrist ganglion

Scaphoid fracture with percutaneous pinning

Distal radius fracture






Finger Traps Index & middle


Overhead traction device


Wrist Scope set up


2.7 mm scope / small joint instrumentation

- insufflate with saline first at 3-4


Wrist Scope Insufflation


Radiocarpal Joint


RCJ is U shaped


Portals are between extensor compartments

- longitudinal incisions to protect extensor tendons

- blunt dissection to preserve SRN branches

- angle 30o volar due to shape distal radius


Wrist scope portalsWrist scope radiocarpal portal


3-4 Portal

- feel Lister's tubercle

- 1 cm distal is soft spot between 3 and 4

- between distal radius and scapholunate

- primary viewing portal


4-5 Portal

- roll finger over mobile 4th compartment

- feel soft spot

- slightly proximal to 3-4 because of slope of radius

- between distal radius and lunatetriquetral

- instrumentation


6-R and 6-U

- Named after their position about ECU

- 6-R working

- 6-U inflow


Midcarpal Joint




MCJ is S shaped

- midcarpal & radiocarpal have separate synovial cavities unless the SLL is torn


Midcarpal radial / MCR Portal

- 1 cm distal to 3/4 portal

- radial side of the third metacarpal axis 

- in line with Lister's tubercle

- soft depression between the capitate and scaphoid

- working portal


Midcarpal ulna / MCU Portal

- 1 cm distal to 4/5 portal

- in line with 4th metacarpal

- distal to lunate-triquetral joint

- proximal to capitate and hamate


Wrist scope portalsWrist Scope Midcarpal Scope


Radiocarpal Joint


Start at radial styloid and scaphoid

- work radial to ulnar


Distal radius


RSC Ligament

- immediately beside is Long RLL

- is extremely wide usually x3 RSCL

- next is short RLL

- often see blood vessels along this ligament


Scapholunate ligament

- examine from membranous prox portion to thicker dorsal ligamentous portion


Wrist scope SL Ligament Radiocarpal joint




Follow ulnarly along lunate and its fossa 

- should be taut like a trampoline 

- actual ballottement with probe should give same feeling 

- trampoline test


Wrist Scope TFCC


Examine for tears 

- central or peripheral

- ulnar styloid recess is normal finding at base of styloid not a tear


Lunate chondromalacia


Midcarpal joint


Curved of head of capitate


Wrist scope midcarpal joint


SL joint


Wrist scope midcarpal joint SL jointWrist scope Midcarpal Joint Normal SL ligament


Lunate-triquetral joint


Wrist Scope Midcarpal Normal Lunate Triquetrum


Specific Conditions


Carpal Instability


SL and LT Ligaments

- must look from radiocarpal and midcarpal joints

- both joint ligaments should be tight and concave

- if inflow in RCJ with midcarpal outflow have tear in ligament


Arthroscopic classification


1.  Attenuation or haemorrhage within ligament

- no step

- can debride partial tears with good results

- Rx cast immobilisation


II. Incongruency or step-off in midcarpal space

- Use k-wire as joy stick to reduce

- treat with arthroscopic pinning

- 80% reported good results


III. Step-off on both sides

- pprobe may be passed between bones

- treat with arthroscopic or open repair


IV. Gross instability

- open repair


TFCC Injuries


Use 4-5 portal as visual portal and 6-R as working portal



- degenerative or traumatic

- central or peripheral

- with or without DRUJ instability

- without or without chondromalacia

- radial or ulnar avulsions

- +/- Styloid fracture




Debride central tears acute or degenerative


Attempt repair of peripheral tears


Unstable DRUJ

- reinforce DRUL or PRUL with strip of ECU


Degenerative tear and ulnar plus 

- add ulnar shortening to debridement

- can perform arthroscopic wafer procedure