Narrow Results

The arthroscopic resection of synovial cysts of the wrist is a simple technique which is comfortable for the patient. We report on a series of 96 patients with dorsal synovial cysts (75 women, 21 men). All patients had undergone preliminary treatment which had been unsuccessful. We operated on 32 patients with a volar cyst (27 women, five men). All the patients were operated on as outpatients under local regional anaesthesia. For the dorsal cysts, after having precisely located the cyst, it is then resected after having inserted a shaver directly through the wall of the cyst starting with the capsule. For the volar cysts the arthroscope was inserted through a 3-4 portal and the shaver was inserted through a 1-2 radiocarpal portal. In all cases, there was no immobilisation and a range of motion was started the same day. For the dorsal cysts, our average follow-up was 34 months (range 12–46 months). There were no complications. We had four recurrences. For the palmar cysts, our average follow-up was 26 months (range 12–39 months). There have been no recurrences to date.

The objective of this study was to provide an assessment of published studies on the wrist arthroscopy. The search was performed from the "Web of Science (WoS) Science Citation Expanded Database" with studies published between January 1, 1990 and March 31, 2011. For research we used the following terms: "Wrist arthroscopy" and "Arthroscopy of the wrist". We located a total of 426 studies about wrist arthroscopic, published in 89 journals over the study period. Of all the publications retrieved (426), original articles were 387 (90.84%), but only two (0.47%) were randomised controlled trials, level 1 of evidence.

This study showed there are a large number of studies on wrist arthroscopy, but the level of methodological evidence is low.

Background: The purpose of this study is to audit the clinical and functional outcomes of arthroscopic ganglionectomy (AG) in our centre.

Methods: A retrospective study was conducted on all 29 patients who underwent AG from 2007 to 2012 with a mean clinic and telephone follow-up duration of 6 months and 32 months respectively.

Results: A total of 29 patients (17 women and 12 men) with a mean age of 38 years underwent AG. 15 patients (52%) had associated pain with the lump, 24 out of 29 patients (83%) had preoperative ultrasound to confirm the diagnosis. All patients had preoperative wrist radiographs that showed no chronic carpal instability and bony pathology. 26 out of 29 patients (90%) had dorsal wrist ganglions and 3 patients (10%) had volar wrist ganglions. 15 out of 24 ganglions (62.5%) were multiloculated. Mean ganglion size clinically and through wrist ultrasound was 2.5 cm and 1.8 cm respectively. During arthroscopy, ganglion stalk was identified in 14 patients (48%). Average operating time was 69.5 minutes. Intraoperatively, 24 out of 29 patients (83%) had wrist synovitis and 26 patients (90%) had associated carpal ligament laxity. 97% of cases were successfully resected arthroscopically. Recurrence rate was 10% (3 cases). There was no significant difference between preoperative and postoperative range of motion of wrists - the mean wrist flexion ranged from 63 to 59 degrees pre and postoperatively, and the mean wrist extension ranged from 66 to 64 degrees pre and postoperatively. Overall grip strength improved from 27 kg to 32 kg ($p>0.05$), and there was also a significant improvement in pain scores pre and post-operatively from visual analogue scale (VAS) score of 0.8 to 0.3 ($p=0.018$). No major intra or post-operative complications occurred. All patients were satisfied in terms of cosmesis.

Conclusions: AG is a safe and reliable alternative to open resection of wrist ganglions. In addition, it can be used as a diagnostic and therapeutic tool for other wrist conditions.

Background: The purpose of this retrospective study was to report outcomes of arthroscopic bone grafting and K-wire fixation to treat scaphoid non-union.

Methods: We included in at two healthcare facilities, 42 consecutive patients (34 men, 8 women) with a mean age of 25 years (range 15–56 years) with scaphoid non-union of the proximal and middle third without intracarpal deformity or SNAC osteoarthritis. All patients were evaluated (pain, range of motion, strength, function, X-rays) by an independent examiner.

Results: At the mean follow-up of 18 months (range 12–56), pain was significantly reduced from 7 to 1 on a visual analogue scale (out of 10). The scores on the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Patient Rated Wrist Evaluation were improved significantly. At the last review, grip strength was 83% of the contralateral side, the average wrist flexion-extension was 125° and the radioulnar deviation was 58°. Bone union was achieved in 37 cases (88%). The mean time of checking the bone union was 3 months (range, 2–8). Four patients required revision surgery because of failed union.

Conclusions: Based on our findings, we found that this procedure can be used as a surgical treatment for scaphoid non-union of the proximal and middle third without intracarpal deformity or osteoarthritis. The arthroscopic bone grafting is a reliable, effective, and minimally invasive procedure.

Publications on lunotriquetral interosseous ligament (LTIL) injuries among adolescent professional golfers are scarce. Inconclusive clinical and radiographic imaging in rendering a definitive treatment may inform the lack of documentation in literature. In this case study, we present three case series of highly competitive adolescent golfers who presented with persistent and intractable ulnar-sided wrist pain. While the physical examination was clinically suspicious for lunotriquetral (LT) ligament injury, plain radiographs and MRI imaging did not elucidate the cause. The diagnosis was confirmed solely via wrist arthroscopy. Although most ulna-sided wrist pain can be treated conservatively, without a proper diagnosis, a missed LTIL injury can be disastrous to an adolescent golfers' future. This case series aims to create awareness of the diagnosis and stress the advantages of utilising wrist arthroscopy.

Level of Evidence: Level V (Therapeutic)