Wrist arthroscopy allows examination inside the wrist joint. Sophisticated set of cameras and lighting provides direct visualisation of important joint structures, sometimes not visible and detectable by any other means/investigations.

Naturally, this is an invasive procedure, so its benefits should be critically evaluated against the risks of intervention. Aims of arthroscopy are generally divided into two main groups:

Diagnostic arthroscopy – just inspect anatomy and exclude/diagnose the pathology so that further treatment can be planned. This is particularly helpful when exact grade of damage needs to be established or other investigations could not provide enough information (CT scan, bone scan, magnetic resonance imaging)

Therapeutic arthroscopy – treat the disease and/or repair damaged structures using special arthroscopic instruments (washout the joint, ‘clean’ inflamed joint lining, remove bone fragments and loose bodies, repair ligaments etc.)

For certain conditions it is possible to achieve both, exploration and treatment in the same arthroscopic setting.

It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:

• Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates.
• Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery
• Plan your time off school / work / sports
• Allow at least few weeks after surgery before considering holiday

The operation is usually performed on a day care basis under general anaesthetic, but it is also possible to numb the whole arm so that you stay awake (even watch television screen and the procedure if brave enough!).

During operation, hand is suspended vertically in order to distend the joint. Tight applicators are put onto the fingers so you might notice very temporary joint ache and skin creases after the surgery. Two to four small skin cuts are made in the wrist through which the camera and instruments are inserted into the joint. Care is taken not to injure the tendons and nerves just under the skin.

A simple look around takes about 30 minutes, but if other procedures are done at the same time it will take longer.

Saline is run into the joint to separate joint surfaces and improve visibility inside the joint. Keyhole wounds are closed with 1-2 sutures and wrist is bandaged for up to 1-2 weeks. If structures have been repaired at the same time, usually postoperative splint is required for few weeks, depending on exact procedure performed.

The patient is fit to go home soon after the operation. The anaesthetic wears off after approximately 6 hours.

Simple analgesia usually controls the pain and should be started before the anaesthetic has worn off.

The hand should be elevated as much as possible for the first 5 days to prevent hand swelling. After surgery you can begin to practice finger exercises straight away. Your wounds may show some blood staining for the first 24 hours, this is quite normal and nothing to worry about. When/if the inner dressing falls off there is no need to replace it unless your clothes rub or catch on the wound. Dressing and bandage should be left in place for two days after the operation (make sure you keep it dry). You will then be able to remove the outer bandage but make sure you leave the inner sticky dressing in place for the first 7 days until it is wound is checked by the nurse, either in the hospital or at the GP practice.

There may be some bruising which usually clears within two weeks.

Any further treatment that the arthroscopy has identified will be discussed at the follow up visit in outpatients, usually 2 weeks after the surgery.

You need to take it easy and get plenty of rest when you get home for the first 2-3 days. You can start to do your usual activities, as you feel comfortable and are able to do so unless I advise you that postoperative plan indicates otherwise. When you return to work will depend on the work you do. Most patients return to work within two weeks but if your job involves physical activity of lifting it may be longer. Taking part in any strenuous activities and return to sport should be discussed at your follow up pending intraoperative findings. It is usually 4-6 weeks after the surgery.

For two days following a general anaesthetic you should not:
Drive a car or ride a motorbike, do not attempt to drive until you are in complete control of your hand. If you are unsure at all you should discuss this with your doctor. It is also advisable to check with your car insurance company, as some policies state that you must not drive for a specified period of time after an operation.

Things to look out for after operation and contact us earlier than planned:

• Disproportionate swelling and pain in your hand
• Signs of infection in vicinity of the operated area i.e. hand/wrist are very hot, prominent redness, pain, swelling, puss collection
• Grazing of the skin (and possibly fluid leaking/oozing from the wounds)
• Increased skin temperature in the scar area
• Offensive wound smell

Like with any other surgical intervention, complications following wrist arthroscopy are general i.e. associated to any hand surgery procedure and specific to wrist arthroscopy:

General complications:

• Skin/wound infection
• Stiffness
• Hypertrophic (lumpy and itchy) scarring
• Numbness
• Reflex Sympathetic Dystrophy – RSD (bad reaction to surgery with painful and stiff hands – this can occur with any hand surgery from a minor procedure to a complex reconstruction)

Specific complications:

• Tendon injury (< 1%)
• Nerve injury
• Numbness
• Neuroma (painful nerve lump extremely sensitive to touch)
• Joint infection

Things to look out for

• Disproportionate swelling and pain in your hand
• Signs of infection in vicinity of the operated area i.e. hand/wrist are very hot, prominent redness, pain, swelling, puss collection
• Grazing of the skin (and possibly fluid leaking/oozing from the wounds)
• Increased temperature in the area
• Strange smells coming from the wounds.

If you notice any of above symptoms in the first few days, feel free to contact the team on numbers below.

This page provides only basic and generic information, but full details and explanations are provided at the consultation as no two patients are the same and each person’s circumstances are highly individual.