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Arthroscopy and upper limb surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Arthroscopic Wafer procedure: abrasion of the distal ulnar head in ulnocarpal conflicts
The ulnocarpal conflict is not a rare condition and should be taken into account in the event of ulnocarpal pain. The conflict is created by too narrow a space of the ulnar head and the ulnar edge of the lunate and the triquetrum. During loading and ulnar deviation of the wrist, a direct contact between these bones is produced. This leads to degenerative changes on the cartilage and produces pain. The origin may be a congenital positive ulnar situation, or a trauma impairing the natural leveling of the forearm bones. We distinguish a fresh traumatic condition (ulnar impaction syndrome) from a chronic condition (ulnar impingement syndrome). The midcarpal bones may also suffer from a similar condition, which is the hamate tip syndrome.
Diagnosis is made by clinical examination including the ulnocarpal stress test, standard X-rays, MRI enhanced with endovenous contrast and subsequent wrist arthroscopy.

Therapeutic options include the ulnar shortening osteotomy and the resection of the distal head of the ulna. Decision can be made depending on the state of the TFCC, the age of the patient and the collateral changes in the wrist. If the lesion occurs in young patients without any concomitant lesion, a shortening osteotomy is more often chosen.

In all other conditions, the less invasive choice for the minimal resection of the distal ulnar head is made by arthroscopic and open surgery. The camera is introduced through the 3-4 portal and the burr through the 6R portal. At the beginning, a 3.5 burr —in more trained hands a 4.2 burr— is used to resect about 2-3 mm of the distal ulnar head during supination and pronation movements. Care is taken not to resect the foveal area or the DRUJ.

After the operation, a comfort splint can be adapted for 3-4 days, and immediate physiotherapy is initiated.
M Haerle
Surgical intervention
7 years ago
692 views
8 likes
0 comments
08:57
Arthroscopic Wafer procedure: abrasion of the distal ulnar head in ulnocarpal conflicts
The ulnocarpal conflict is not a rare condition and should be taken into account in the event of ulnocarpal pain. The conflict is created by too narrow a space of the ulnar head and the ulnar edge of the lunate and the triquetrum. During loading and ulnar deviation of the wrist, a direct contact between these bones is produced. This leads to degenerative changes on the cartilage and produces pain. The origin may be a congenital positive ulnar situation, or a trauma impairing the natural leveling of the forearm bones. We distinguish a fresh traumatic condition (ulnar impaction syndrome) from a chronic condition (ulnar impingement syndrome). The midcarpal bones may also suffer from a similar condition, which is the hamate tip syndrome.
Diagnosis is made by clinical examination including the ulnocarpal stress test, standard X-rays, MRI enhanced with endovenous contrast and subsequent wrist arthroscopy.

Therapeutic options include the ulnar shortening osteotomy and the resection of the distal head of the ulna. Decision can be made depending on the state of the TFCC, the age of the patient and the collateral changes in the wrist. If the lesion occurs in young patients without any concomitant lesion, a shortening osteotomy is more often chosen.

In all other conditions, the less invasive choice for the minimal resection of the distal ulnar head is made by arthroscopic and open surgery. The camera is introduced through the 3-4 portal and the burr through the 6R portal. At the beginning, a 3.5 burr —in more trained hands a 4.2 burr— is used to resect about 2-3 mm of the distal ulnar head during supination and pronation movements. Care is taken not to resect the foveal area or the DRUJ.

After the operation, a comfort splint can be adapted for 3-4 days, and immediate physiotherapy is initiated.
Arthroscopic radial styloidectomy: technique, indication, results
The first case of arthroscopic radial styloidectomy was reported by Ruch in 1998.
Indications of radial styloidectomy are relative to radioscaphoidal impingement without alteration of the mid-carpal joint by degenerative arthritis (SNAC and SLAC stage 1 and 2). Pseudarthrosis of the radial styloid is another rare indication of radial styloidectomy.
The quantity of radius to remove was evaluated in different studies between 3 and 4mm. Removing more than 4mm of radius may lead to a destabilization of the wrist due to the insertion of ligaments on the anterior marginal part of the radius. No case of carpal destabilization after radial styloidectomy was reported in the literature.
The design of osteotomy may be different depending on the origin of the conflict. SNAC and SLAC lead to different kinds of arthritis and impingement.
Arthrocopy is a very useful tool to carry out radial styloidectomy; it is a minimally invasive procedure with the possibility of early rehabilitation. In case of poor results, there is still a place for open surgery.
To better visualize the expert's powerpoint presentation, please click here.
JM Cognet
Lecture
8 years ago
357 views
2 likes
0 comments
12:16
Arthroscopic radial styloidectomy: technique, indication, results
The first case of arthroscopic radial styloidectomy was reported by Ruch in 1998.
Indications of radial styloidectomy are relative to radioscaphoidal impingement without alteration of the mid-carpal joint by degenerative arthritis (SNAC and SLAC stage 1 and 2). Pseudarthrosis of the radial styloid is another rare indication of radial styloidectomy.
The quantity of radius to remove was evaluated in different studies between 3 and 4mm. Removing more than 4mm of radius may lead to a destabilization of the wrist due to the insertion of ligaments on the anterior marginal part of the radius. No case of carpal destabilization after radial styloidectomy was reported in the literature.
The design of osteotomy may be different depending on the origin of the conflict. SNAC and SLAC lead to different kinds of arthritis and impingement.
Arthrocopy is a very useful tool to carry out radial styloidectomy; it is a minimally invasive procedure with the possibility of early rehabilitation. In case of poor results, there is still a place for open surgery.
To better visualize the expert's powerpoint presentation, please click here.
Ulnar impaction syndrome
Ulno-carpal impaction syndrome is often secondary to the sequels of a fracture of the distal radius.
The inversion of the distal radio-ulnar index with a positive ulnar variance by shortening relative to the radius eventually leads to an abutment between the head of the ulna and the proximal articular face of the lunate. This contact leads to the alteration of the cartilaginous carpal surfaces. There are numerous treatments for the distal radio-ulnar component of malunion of distal radius fracture and the choice of therapy is based on specific evaluation of this joint through a clinical and radiological analysis.
Arthroscopy remains the best diagnostic element in evaluating the seriousness of the ulno-carpal abutment with a direct visualization of the cartilaginous lesions and allowing a precise assessment of the associated lesions, in particular on TFCC or LT ligament. When the inversion of the distal radio-ulnar index is less than or equal to 5mm, the surgical treatment can also be carried out by arthroscopy.
JR Haugstvedt
Lecture
8 years ago
380 views
6 likes
0 comments
10:08
Ulnar impaction syndrome
Ulno-carpal impaction syndrome is often secondary to the sequels of a fracture of the distal radius.
The inversion of the distal radio-ulnar index with a positive ulnar variance by shortening relative to the radius eventually leads to an abutment between the head of the ulna and the proximal articular face of the lunate. This contact leads to the alteration of the cartilaginous carpal surfaces. There are numerous treatments for the distal radio-ulnar component of malunion of distal radius fracture and the choice of therapy is based on specific evaluation of this joint through a clinical and radiological analysis.
Arthroscopy remains the best diagnostic element in evaluating the seriousness of the ulno-carpal abutment with a direct visualization of the cartilaginous lesions and allowing a precise assessment of the associated lesions, in particular on TFCC or LT ligament. When the inversion of the distal radio-ulnar index is less than or equal to 5mm, the surgical treatment can also be carried out by arthroscopy.