Wrist Arthroscopy

Why this approach — at MOS

Wrist arthroscopy bridges the diagnostic and therapeutic gap for patients with persistent wrist pain that has not been fully explained or successfully managed non-operatively. The direct visualization it provides confirms or revises pre-operative diagnoses and grades ligament injuries accurately — which matters because the grade of a scapholunate or lunotriquetral ligament tear determines whether débridement, repair, or reconstruction is the appropriate treatment.

At Maryland Orthopedic Specialists, Dr. Fitzgibbons uses wrist arthroscopy as both a primary diagnostic and therapeutic tool and as an adjunct to open procedures. When performing distal radius ORIF for intra-articular fractures, arthroscopy is used to confirm the quality of articular reduction from inside the joint — a perspective fluoroscopy cannot provide. For patients in Bethesda and the wider Montgomery County area presenting with chronic or post-traumatic wrist pain, arthroscopy provides diagnostic clarity that may not be achievable with imaging alone.

Patient selection is key. Wrist arthroscopy is not appropriate for advanced arthritis or for pain that has not received adequate conservative management. But for patients with structural pathology identified on imaging who have failed appropriate non-operative care, it is both a practical diagnostic tool and an effective minimally invasive treatment.

Who is a candidate?

Indications

• Persistent wrist pain for 3–6 months despite conservative management, with inconclusive or incomplete imaging findings
• TFCC tear confirmed or suspected on MRI — arthroscopy allows classification of the tear type and determines whether débridement or repair is appropriate
• Scapholunate or lunotriquetral ligament injury evaluation and treatment
• Removal of wrist loose bodies or cartilage flaps
• Synovitis not responsive to conservative treatment or injection
• Dorsal ganglion cyst — arthroscopic excision from inside the joint
• Concurrent with distal radius ORIF to assess and improve intra-articular fracture reduction
• Scaphoid fracture assessment of the scapholunate interval

Contraindications

• Significant wrist osteoarthritis with bone-on-bone changes — arthroscopy has limited treatment potential in advanced arthritis
• Active skin infection over the dorsal wrist
• Wrist stiffness severe enough to prevent adequate joint distraction for arthroscope introduction

Conservative Treatment First

Most wrist pain — including pain from ligament sprains, TFCC tears, and synovitis — improves with non-surgical treatment. Rest, splinting, anti-inflammatory medications, and corticosteroid injection into the wrist joint can resolve symptoms in many patients with partial ligament injuries and central TFCC tears. A structured trial of 3–6 months of conservative management is appropriate for patients with non-acute wrist pain and no clear surgical indication on imaging.

When pain persists beyond this period, when a reperable structural injury is identified on MRI, or when the patient's function is significantly limited, arthroscopy provides both a definitive diagnosis and the opportunity for minimally invasive treatment.

The procedure

What Is Wrist Arthroscopy?

Wrist arthroscopy is a minimally invasive procedure in which a small camera is inserted into the wrist joint through tiny incisions to diagnose and treat wrist problems including cartilage tears, ligament injuries, synovitis, and loose bodies. It allows direct visualization of the wrist joint interior without the need to open the joint fully.

The wrist is one of the most complex joints in the body, containing eight carpal bones, multiple intrinsic ligaments, the radioulnar joint, and the TFCC (triangular fibrocartilage complex) on the ulnar side. This complexity makes accurate diagnosis of wrist pain challenging. MRI is the primary imaging tool for wrist pathology, but even high-quality MRI can miss small or partial ligament tears, and some pathology is only apparent when the joint is directly inspected under arthroscopic magnification. Wrist arthroscopy provides both a diagnostic answer and, in many cases, a therapeutic solution in the same procedure.

The arthroscope — a pencil-thin camera — is inserted through 2–3 mm portals (small openings) between the extensor tendons on the back of the wrist. Saline solution inflates the joint for visualization. The surgeon examines the articular cartilage of the radius and carpal bones, the scapholunate and lunotriquetral ligaments, the TFCC, and the radiocarpal and midcarpal joint compartments. Operative instruments can be inserted through additional portals to débride damaged tissue, repair tears, remove loose bodies, or perform other interventions.

What Happens During Wrist Arthroscopy?

Setting and anesthesia: Wrist arthroscopy is performed at an ambulatory surgery center under regional anesthesia (a brachial plexus or wrist block) or general anesthesia. The procedure takes 30–60 minutes depending on the pathology treated. You are discharged the same day.

Setup: The arm is placed in a finger-trap traction device that suspends the hand from a tower, distracting the wrist joint to create space for the arthroscope. Approximately 10–15 pounds of traction is applied to the fingers. The dorsal wrist is cleaned and draped.

Portal placement: Standard portals are made between the extensor tendons. The 3-4 portal (between the third and fourth extensor compartments) is the primary viewing portal. The 4-5 portal and 6R portal provide working access. Additional portals may be made for the midcarpal joint. Each portal is created with a small stab incision through the skin and a blunt trocar through the joint capsule.

Diagnostic assessment: The camera is inserted and the joint systematically examined: the radiocarpal joint cartilage, the radial styloid, the scapholunate ligament (tested with a probe for integrity — the Geissler grading system stages partial and complete tears), the lunotriquetral ligament, the TFCC, and the distal radioulnar joint. Findings guide the operative portion of the procedure.

Operative interventions: Depending on findings, the surgeon may débride a central TFCC tear (removing frayed edges), repair a peripheral TFCC tear with sutures, débride an inflamed synovial lining, remove a cartilage fragment or loose body, or excise a ganglion cyst stalk. Thermal radiofrequency devices can be used to tighten lax ligaments in selected cases.

At the conclusion, the portals are closed with sutures or Steri-Strips and a bulky dressing applied.

Recovery timeline

Frequently Asked Questions