Wrist Arthroscopy
Wrist arthroscopy is a closed surgical technique used for injuries of the TFCC (triangular fibrocartilage complex), ligament problems and resistant pain arising within the joint. It is one of the smallest joints in which arthroscopy is performed and requires work with very fine instruments.
The Structure of the Wrist
The wrist is a complex region made up of numerous small joints and ligaments formed by the two forearm bones and eight carpal bones. The TFCC, on the outer side of the forearm, carries load on the little-finger side of the wrist and provides balance during rotation of the forearm. Because these structures are small, problems cannot always be seen clearly on imaging.
In Which Conditions Is It Considered?
- TFCC injuries — one of the common causes of pain on the little-finger side of the wrist
- Ligament injuries — particularly scapholunate and lunotriquetral ligament problems
- Ganglion cysts — assessment of cysts arising from within the joint
- Assessment and treatment of cartilage lesions
- Removal of loose bodies within the joint
- Inspection of the joint surface under imaging guidance in wrist fractures
- Chronic synovitis and rheumatological joint problems
- Assessment of resistant wrist pain of unclear cause
Why Are Some Wrist Problems Difficult to Diagnose?
Because the structures in the wrist are numerous and small, some injuries may not be clearly distinguished on MRI. When examination findings and imaging do not agree, seeing the structures inside the joint directly can clarify the diagnosis. The wrist is therefore one of the joints where the diagnostic contribution of arthroscopy is most evident.
Diagnosis and Assessment
- History: the site of pain (thumb side / little-finger side), any history of a fall or strain, occupation and repetitive movements.
- Physical examination: points of tenderness, grip strength, ligament stability tests, assessment of forearm rotation.
- X-ray: bone alignment, fracture, distance between the bones.
- MRI: assessment of the TFCC, ligaments and soft tissues.
Wrist pain can also be confused with conditions such as carpal tunnel syndrome and tendon sheath problems; differential diagnosis is important.
Conservative Treatment First
In most wrist problems the first approach is not surgical: activity modification, rest with a splint or brace, pain management and a hand therapy programme are applied first. Surgery is considered where there has been no response to these treatments, or in injuries requiring structural repair.
How Is the Procedure Performed?
In wrist arthroscopy the wrist is generally suspended gently in a specialised traction device and the joint space is opened. Fine cameras of 2–3 mm in diameter and micro instruments are used. Depending on the problem identified, TFCC repair or reshaping, ligament assessment, removal of a cyst or intra-articular debridement may be carried out.
Preparing for the Procedure
- Prepare an up-to-date list of every medication you take, including herbal supplements.
- If you take blood thinners, be sure to say so; your physician decides when they are stopped.
- Bring any previous MRI, X-ray and operation reports with you.
- Follow the fasting instructions; this is critical for the safety of anaesthesia.
- Arrange your transport home and someone to accompany you in advance.
For detailed preparation headings, see the Preparing for Orthopaedic Surgery page.
The Postoperative Period
Where a repair has been carried out the wrist is protected for a period in a splint or cast; where only debridement has been performed, movement can be started earlier. Finger movements are recommended early to reduce swelling and prevent stiffness. Hand therapy plays an important role in regaining grip strength and fine movements.
Risks and What You Should Know
Although arthroscopy is a closed technique, it is still a surgical procedure and every surgical procedure carries risks. The headings below are for general information; your individual risk assessment is made by your physician after examination and investigations.
- Infection — a risk present in every operation, despite the small portals.
- Bleeding or swelling within the joint
- Involvement of nerve and vessel structures (rare)
- Risk of clot formation (deep vein thrombosis), particularly in lower limb procedures
- General risks related to anaesthesia
- Failure to achieve the expected improvement, or persistence of symptoms
- Temporary numbness from involvement of superficial sensory nerves
- Temporary stiffness of the wrist and reduced grip strength
- Healing of the repaired tissue not reaching the expected level
The decision to operate is made by weighing together the duration and severity of symptoms, examination findings, imaging results, age, occupation, activity level and any accompanying conditions. Outcomes vary from person to person.
When Should You Seek Assessment?
- If wrist pain has not settled for weeks
- If rotational movements such as turning a door handle or opening a jar cause pain
- If there is catching, noise or a sense of giving way in the wrist
- If you notice a reduction in your grip strength
- If pain and swelling persist after a fall
Frequently Asked Questions
What is a TFCC tear?
The TFCC is the cartilage–ligament structure on the little-finger side of the wrist that carries load and provides balance during rotation of the forearm. It can be injured by a fall or by repetitive strain. Not every TFCC tear requires surgery; symptoms, examination and stability are assessed together.
I had an MRI for wrist pain but nothing was found — what should I do?
Because the structures in the wrist are small, some injuries may not be clearly visible on MRI. If symptoms continue, repeat examination, different imaging methods or, in selected cases, diagnostic arthroscopy may be considered.
Does a ganglion cyst always require surgery?
No. Some ganglion cysts shrink or disappear on their own. Surgery may be considered for cysts that cause pain, restrict movement or recur.
When can I use my hand after the operation?
Finger movements are generally started early; use of the wrist depends on the procedure performed. The protection period is longer where a repair has been carried out. Your physician determines the exact timeframe.
Is wrist arthroscopy used in carpal tunnel syndrome?
Carpal tunnel syndrome is not a problem inside the wrist joint but a compression of the nerve within the tunnel; its treatment is a different surgical procedure. However, the two conditions can be present together in the same patient.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of hand and wrist surgery and related areas of arthroscopic surgery. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Arthroscopic Surgery (Keyhole Joint Surgery)
- Hand and Wrist Surgery
- Carpal Tunnel Syndrome
- Trigger Finger
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any surgical or medical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.