Rationale:

When the patient approaches the wrist surgeon with a prevalent persistent pain, swelling or clicking in the wrist in spite of having been provided treatment by NSAIDs, corticosteroid injections or splinting, relief is sought to be provided by alternative means of treatment. The accurate way to diagnose the cause is an internal assessment of the ligaments, bones and cartilage that form the wrist joint. A minimally invasive procedure referred to as Arthroscopy is undertaken to evaluate the damage and repair it thenceforth.

Introduction to the Technique:

Wrist Arthroscopy is a surgical procedure used to identify and then remove or repair damaged tissues in the wrist that are causing its degradation. With implementation of small incisions, camera and precise instruments the patient is assured relief with minimal pain and disruption to the surrounding tissues. The procedure may take about 20 minutes to 2 hours to complete depending on the severity of the condition that is being taken up.

Conditions for Arthroscopy:

Indications and applications of wrist Arthroscopic Repair are extended to patients who have sustained an injury or are affected by any degenerative disease in the wrist. Wrist Arthroscopy can be used either as an operative technique or a diagnostic tool or both for any of the following conditions-

• - Damage in cartilage,
• - Abnormal skin growth,
• - Excessive joint lining,
• - Fractures of distal radius and scaphoid
• - Removal of loose bodies
• - Management of arthritic joints
• - Repair of TFCC

Pre-Procedural Evaluation:

After the decision of repair by Arthroscopy is taken the wrist surgeon gathers all information regarding past medical history, consumption of medicines, any bad habits, allergies or reactions to anesthesia or chemical compositions that might affect the surgery. The patient is asked to undergo a few medical tests to ensure that the patient is healthy for Arthroscopy. Prior to the surgery a set of instructions is given to the patient regarding prohibitory activities, consumption of medications, food or alcohol so that they do not interfere with the surgery.

Performing the Procedure:

After giving the patient general or regional anesthesia the wrist surgeon makes a small incision on the wrist to insert an arthroscope (camera) to view inside the joint. After inspecting all the tissues the wrist surgeon repairs any damaged tissues. To perform the removal or repair the surgeon makes a few more incisions through which he inserts special arthroscopic instruments. Severely damaged tissue is removed and the muscle, cartilage, tendon or ligament is repaired. After the procedure is completed the wrist surgeon closes the stitches and puts a protective bandage on the surgery.

Postprocedural Follow up:

After arthroscopic repair the wrist is aptly bandaged and then placed in a splint to immobilize it. The patients are made to understand post operative care that they shall have to take and instructions regarding elevation of the wrist to avoid pain and swelling. A follow up appointment with the wrist surgeon is scheduled and the patient is also provided physical therapy as per requirement.

Recovery:

Recovery varies from patient to patient. Usually arthroscopic repair has a high success ratio of with patients resuming their work from within days after surgery to a few weeks or months, depending on the condition they have been taken up for.

Risks Involved:

Wrist Arthroscopy is a keyhole surgery but is prone to certain risks that might debilitate the condition of the patient further. The complications likely to occur in the surgery are-

• - The repair fails to heal
• - The surgery fails to relieve the patient of the persistent symptoms of pain and swelling
• - There is prevalent weakness in the wrist after surgery
• - Injury to a tendon, nerve or blood vessel
• - Infection in the incisions
• - Excessive bleeding
• - Allergic reaction to anesthesia

Benefits Involved:

Arthroscopy involves very small cuts hence the patient is left with scarcely visible surgical scars. The small cuts facilitate faster recovery with occurrence of mild complications. It is an outpatient surgery and thus the patient is saved from the anxiety of an overnight stay in the hospital.

Rehabilitation:

Considered to be an essential prerequisite for restoring wrist mobility after the arthroscopic repair, a well formulated rehabilitative program comprising of massage, manual therapy and exercise regime is chalked for the patient which is monitored by a skilled physical therapist.

More about wrist surgeon:

Dr. Vikas Gupta is an acclaimed professional in the field of upper extremity. Based at Max Healthcare presently as the head of hand and shoulder division, Dr. Gupta strives to deliver treatment for each and every debilitation in the upper extremity that result from traumatic injuries or congenital and degenerative diseases. Dr. Gupta has been awarded with prestigious honors for his exemplary and significant contribution to the field after being in the profession for more than 25 years and more than 6000 surgical releases. His forte of deliverance over the years have been AIIMS, Fortis, Medanta- the Medicity and presently Max Healthcare. As an MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi and post graduate studies from Germany and USA, Dr. Gupta has been Introductory of many international and painless techniques and emerged as highly influential role model for his peers and interns. With an extremely calm demeanor and compassionate approach he makes patients seek his medical advice and with deftness in surgical skills and accurate diagnosis he has proven to be an outstanding specialist. Max Healthcare, his present forte of deliverance is a super specialty hospital that believes in proving the best, most cost effective and painless techniques to their patients through international machines and team of ingenious professionals.