Arthroscopy is a good way to get to the bottom of chronic and acute wrist pain and problems. Arthroscopy is an alternative to imaging procedures such as x-rays, computed tomography (CT) and MRI of the hand (magnetic resonance imaging). The advantage of arthroscopy is that lesions and problem points can be displayed more precisely.
The disadvantages are that arthroscopy is an invasive procedure in contrast to imaging techniques. In a surgical procedure, the patient must be given an anaesthetic (sedation) in a sterile environment, while imaging requires only a short moment without major further effort. Furthermore, arthroscopy is a much more cost-intensive procedure.
This is partly because the procedure requires practice and professional experience on the part of the physician, and partly because several devices and instruments are used in the operating room during the procedure. A major advantage is again that arthroscopy can be used not only for diagnosis but also for treatment. It is thus a considerable step ahead of imaging procedures.
Indication
Today, arthroscopy of the wrist is rarely used as a purely diagnostic measure. Rather, it is usually performed as part of a diagnostic and surgical procedure. Arthroscopy is used to treat acute wrist problems, for example after various traumas (wrist fracture).
During arthroscopy, the fracture can be repositioned (brought back) and fixed in place. Arthroscopy can often reveal concomitant injuries in the fracture area that could not have been visualized using imaging techniques. Another area of application is chronic wrist complaints (for example wrist arthrosis). Patients often come for arthroscopic treatment after long periods of time, as the conventional methods have not been able to achieve a clear diagnosis or remedy the problem.
Preparation for arthroscopy
In the course of arthroscopy, an axillary plexus anaesthesia is usually performed. This means that the nerve cords that run into the arm via the shoulder-armpit area are anaesthetised in the armpit, so that the patient no longer has any sensation in the arm from the shoulder downwards. If it is already clear in advance that this is a longer and more complex procedure, then an anaesthetic can also be used in which the patient is intubated.
An advantage of axillary anaesthesia is that the patient is still able to communicate and can follow the arthroscopy if interested. Furthermore, depending on the reason for the arthroscopy, a bloodless or tourniquet is applied to the affected arm. In a tourniquet, blood flow into the arm is prevented, for example by inflating a blood pressure cuff on the upper arm with a pressure that exceeds the systolic blood pressure.
This puts the arm into a state of anemia (ischemia). The reason for this is that blood loss in the area of the surgical site can be prevented. Another advantage is that the surgical site remains free of blood and is therefore easier for the doctor to see.
The tourniquet is used for chronic wrist diseases, among others. The tourniquet is used when there is a recent trauma that is to be treated by arthroscopy. In this procedure, a tourniquet is also created by means of a cuff on the upper arm.
Before the cuff is fully inflated, the blood in the arm is squeezed out. This is done by winding the arm tightly. When this wrapping process is finished, the cuff is completely inflated and the arm remains in a bloodless state.
In addition to the anaesthesia, a special positioning of the patient takes place during the preparation. The main purpose of this is to apply a traction to the joint to be arthroscopied. The traction is necessary to expand the joint space.
This is the only way for the surgeon to have a sufficient view of the joint. This traction is created with the help of girl catchers or extension sleeves. This is a braid-like tube which is closed at the tip.
With the open side the tube is pushed onto the finger and tightened. At the closed tip there is a hook with which the extension sleeve can be put under tension. Such extension sleeves are attached to the index, middle and ring finger and then tightened in vertical or horizontal position. Which position is chosen depends on the reason for the arthroscopy and the treating physician.
