The role of arthroscopy in the management of chronic wrist pain

摘要

Purpose:The aim of this study was to evaluate the usefulness of arthroscopy in the management of chronic wrist pain in selected cases (those with suspected pathology or therapeutic consideration). Methods:58 patients were reviewed, post arthroscopy, over a period of seven years. There were 31 females and 27 males. The commonest diagnosis (in 21 patients) was a tear of the Triangular Fibrocartilage Complex (TFCC) followed by Ganglia, in 12. Results:In 31 (53%) of patients) the preoperative diagnosis correlated with the operative findings. In 30 patients (52%) the symptoms resolved following arthroscopy. Secondary procedures were required in 18 (31%). Arthroscopy altered the management in 42 (72%) of patients.Conclusion:We conclude that arthroscopy of the wrist is valuable in the management of chronic wrist pain. Introduction Although chronic wrist pain is common, it can be difficult to reach a diagnosis when the physical signs are vague or equivocal. Various investigations are available; plain radiographs (with and without stress views), isotope bone scans; Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are often used. Another option is arthroscopy which has been used increasingly since its first description by Chen in 1979 (3). It is considered the gold standard as the surgeon can visualise the pathology, diagnose it and treat simultaneously. The aim of this study was to evaluate its effectiveness in the management of these problems. Materials And Methods We performed a retrospective study of patients with symptoms of longer than three months duration (median 6 months). The study period was from 1997 to 2003. All the patients were seen, examined and operated on by the senior author. Plain radiographs were taken and, where appropriate, stress views were performed. Whenever possible, a clinical diagnosis was made and recorded in the patient's notes. No MRI scans were performed as it was not available in the district general hospital during the study period.Patients' occupations were classified according to the Office of Population, Censuses and Survey (OPCS) into Light manual worker, Clerical, Heavy manual worker and Not defined. The findings at wrist arthroscopy were compared with the presumptive diagnoses. TechniqueAll the arthroscopies were performed as day cases under general anaesthesia. An upper arm tourniquet was used, the radiocarpal joint filled with saline and traction applied. The radiocarpal joint was examined through the three/four portal and instruments introduced through the four/five or five/Ulnar. The midcarpal joint was examined in each case through the Midcarpal Radial portal (MCR) and instruments introduced through the Midcarpal Ulnar (MCU). Local anaesthetic (0.5% Bupivacaine) was injected at the end of procedure followed by a compression bandage (no sutures were required) which was reduced in 48hrs and a single tubigrip applied. The patients were allowed to mobilise the wrist freely. Physiotherapy was not routinely prescribed. Results There were 58 patients with an average follow up of 12months (6 – 72months). All the patients were reviewed within a year of their operation. There were 27 males and 31 females. The age range was 18years – 57yrs (mean = 33.68 years). The wrist arthroscopy was performed on the right side in 32 cases and on the left side in 26 cases. There were no operative complications.The operative diagnoses are summarised in Table 1.