Arthroscopy

 

Indications

 

TFCC tears

Scapholunate / lunotriquetral instability

Wrist ganglions

Scaphoid fracture with percutaneous pinning

Distal radius fracture

 

Technique

 

Vumedi wrist arthroscopy portal placement video

 

Vumedi wrist arthroscopy anatomy video

 

Set up

 

Finger traps index & middle finger with overhead traction device

- 2.7 mm scope

- insufflate joint with saline 

 

 

Radiocarpal joint arthroscopy

 

Portals

 

Portals are between extensor compartments

- longitudinal incisions to protect extensor tendons

- blunt dissection to preserve superficial radial nerve branches

- angle 30^o volar due to shape distal radius

- radiocarpal joint U shaped

 

 

3-4 Portal / Primary viewing portal

- 1cm distal to Lister's tubercle

- soft spot between 3rd and 4th extensor compartments

- 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

 

Technique

 

Work radial to ulna

- scaphoid / radioscapolunate ligament / long radiolunate ligament

- scapholunate ligament membranoous portion

- lunate / short radiolunate ligament / ulnolunate ligament

- TFCC

 

www.boneschool.com/scapholunate-ligament

www.boneschool.com/TFCC-tears

 

Membranous portion of the SL ligament from the radiocarpal ligament

 

Normal TFCC and ulna sided TFCC tear

 

Midcarpal joint arthroscopy

 

 

Midcarpal joint is S shaped and a separate synovial cavity

 

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

 

Technique

- STT joint

- scapholunate joint

- lunate-triquetral joint

- capitate / hamate

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Normal scapholunate ligament midcarpal arthroscopy

 

Torn scapholunate ligament midcarpal arthroscopy

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