Wrist Arthroscopy Explained
In short: Wrist arthroscopy is keyhole surgery of the wrist, in which a surgeon inserts a pencil-thin camera through small incisions to see and treat the inside of the joint. Wrist arthroscopy is used to diagnose unexplained wrist pain and to repair problems such as tears of the triangular fibrocartilage complex (TFCC), damaged cartilage and torn ligaments. Recovery is faster than open surgery because the incisions are tiny — most people return to desk work within one to two weeks, with a full recovery over six to twelve weeks depending on what was treated.
What is wrist arthroscopy?
Wrist arthroscopy is a minimally invasive operation that uses a small camera to look inside and treat the wrist joint through incisions of only a few millimetres. The camera, called an arthroscope, is a pencil-thin telescope connected to a high-definition monitor, and it gives the surgeon a magnified, close-up view of the structures inside the wrist that no scan can match. Fine instruments are passed through separate small incisions to repair, trim or remove damaged tissue.
The wrist is a compact joint containing eight small carpal bones, the ends of the two forearm bones and a network of ligaments and cartilage. Because these structures are so small and closely packed, a magnified direct view is often the most reliable way to find the source of a problem. Wrist arthroscopy is used both to make a diagnosis and, in the same sitting, to carry out treatment.
What conditions does wrist arthroscopy treat?
Wrist arthroscopy treats a range of problems inside the wrist joint, most commonly tears of the triangular fibrocartilage complex, ligament injuries and damaged cartilage. The triangular fibrocartilage complex (TFCC) is a cushion of cartilage and ligament on the little-finger side of the wrist, and a tear there is one of the most frequent reasons for the procedure.
Conditions treated or assessed by wrist arthroscopy include:
TFCC tears, which cause pain on the little-finger side of the wrist and a painful click when twisting the forearm
Ligament tears, particularly of the scapholunate ligament that links two of the carpal bones
Cartilage damage and loose fragments within the joint
Chronic wrist pain of unclear cause, where arthroscopy provides a definitive diagnosis
Fractures involving the joint surface, where the camera helps line up the fragments precisely
Deciding whether arthroscopy is the right procedure depends on the diagnosis, the findings on examination and the results of any scans taken beforehand.
When is wrist arthroscopy recommended?
Wrist arthroscopy is recommended when wrist pain or instability persists despite rest, splinting and physiotherapy, and when the exact cause needs to be confirmed or treated directly. Persistent pain that limits work or sport, a wrist that clicks or gives way and swelling that will not settle are common reasons to consider the procedure.
Arthroscopy is usually not the first step. Most wrist problems are assessed first with examination, X-rays and often an MRI scan, and many settle with non-surgical treatment. Wrist arthroscopy comes into its own when the diagnosis remains unclear after scans, or when a scan has shown a tear that would benefit from repair. A scan can suggest a TFCC or ligament tear, but arthroscopy shows the tear directly and allows it to be graded and repaired at the same time.
What happens during wrist arthroscopy?
During wrist arthroscopy the wrist is gently held in slight traction, the arthroscope is inserted through a small incision on the back of the wrist and the joint is examined systematically before any treatment is carried out. The operation is performed as a day case under sedation & regional anaesthetic, or general anaesthetic, and usually takes between 30 minutes and 90 minutes depending on what is found and repaired.
Two or more incisions of a few millimetres are made on the back of the wrist. The joint is filled with sterile fluid to open up the space and improve the view, and the surgeon moves the camera through the joint, inspecting the cartilage, the ligaments and the TFCC in turn. When a problem is found, fine instruments are used to trim a frayed tear, remove loose fragments or place stitches to repair a torn TFCC. At the end the fluid is drained, the tiny incisions are closed with a stitch or adhesive strips and the wrist is bandaged, sometimes in a light splint.
What is recovery like after wrist arthroscopy?
Recovery after wrist arthroscopy is quicker than after open wrist surgery, and the pace depends mainly on whether the procedure was purely diagnostic or included a repair. After a diagnostic arthroscopy or a simple trimming of a tear, many people are back to light activities within a few days. After a TFCC or ligament repair, the wrist is protected for longer to allow the stitched tissue to heal.
The first week centres on keeping the hand elevated to reduce swelling, moving the fingers freely and keeping the dressing dry. Discomfort is usually modest and controlled with simple painkillers.
Weeks one to three allow a return to desk-based work and light daily tasks once the wounds have healed, typically within one to two weeks after a diagnostic procedure. After a repair, a splint or a cast may be worn for up to four to six weeks.
Weeks three to six are guided by a hand therapist, who introduces exercises to restore movement and, later, grip strength. Returning to driving depends on regaining a secure grip and rotation of the forearm.
Weeks six to twelve see the return of heavier lifting, manual work and sport. A full recovery after a repair can take three months or occasionally longer, and hand therapy through this period gives the best result.
What are the risks of wrist arthroscopy?
Wrist arthroscopy is a safe procedure with a low complication rate, and because the incisions are tiny, the risks are lower than with open surgery. Most patients have no problem beyond temporary swelling and stiffness that settle over a few weeks.
The recognised risks, though uncommon, include infection at one of the small wounds, temporary numbness where a small skin nerve runs close to an incision, stiffness of the wrist and swelling. Injury to the tendons or deeper nerves is rare in experienced hands. As with any operation there is a small risk related to the anaesthetic, which is discussed beforehand. The prospect of these complications is weighed against the benefit of a precise diagnosis and a targeted repair, and for the great majority of patients the balance is firmly in favour of the procedure.
Wrist arthroscopy compared with open surgery
Wrist arthroscopy offers a magnified view of the joint through incisions of a few millimetres, whereas open surgery requires a larger incision to expose the same structures. The keyhole approach generally means less disturbance to the surrounding tissues, less post-operative pain, smaller scars and a faster early recovery.
Arthroscopy is not suitable for every wrist problem. Some complex reconstructions, advanced arthritis and certain fractures are still better treated by an open operation, where the surgeon needs full access to rebuild or realign the joint. The decision between keyhole and open surgery rests on the diagnosis, the extent of the damage and what the joint needs, and both approaches are sometimes combined in the same operation — arthroscopy to assess and prepare, followed by a small open step to complete the repair.
My approach to wrist arthroscopy
In my London and Hertfordshire practice, wrist arthroscopy is a procedure I use both to solve the puzzle of unexplained wrist pain and to carry out precise repairs of TFCC and ligament injuries. Many patients come to me after months of wrist pain that has not been fully explained by scans, and a short arthroscopic assessment often provides both the answer and the treatment in a single day-case operation.
My preference is always to exhaust sensible non-surgical treatment first — rest, splinting and hand therapy resolve a great many wrist complaints without an operation. When arthroscopy is the right step, I discuss exactly what it involves, what I expect to find and the realistic recovery for the specific repair planned. I perform wrist arthroscopy at Spire Bushey Hospital, One Hatfield Hospital and Pinehill Hospital in Hertfordshire, and in London.
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Frequently asked questions about wrist arthroscopy
How long does wrist arthroscopy take? Wrist arthroscopy usually takes between 30 minutes and 90 minutes, depending on whether it is a diagnostic look inside the joint or includes a repair such as stitching a TFCC tear. The procedure is performed as a day case, so you go home the same day. The time under anaesthetic is longer than the surgery itself once preparation and recovery are included.
Is wrist arthroscopy painful? Wrist arthroscopy causes only modest pain for most patients, because the incisions are just a few millimetres long. Discomfort and swelling in the first few days are usually well controlled with simple painkillers and by keeping the hand elevated. Pain settles more quickly than after open wrist surgery, though a repair that is protected in a splint takes longer to feel fully comfortable.
How long is recovery after wrist arthroscopy? Recovery after a diagnostic wrist arthroscopy is often one to two weeks for desk work and light tasks. After a TFCC or ligament repair, the wrist is protected in a splint for up to four to six weeks, and a full recovery with the return of grip strength and sport takes around three months. Hand therapy guides the later stages.
Will I need a cast after wrist arthroscopy? Whether you need a cast depends on what was done. After a purely diagnostic arthroscopy or a simple trimming, a light bandage or removable splint is usual and no cast is needed. After a ligament or TFCC repair, a cast or firm splint is often worn for four to six weeks to protect the stitched tissue while it heals.
Can a TFCC tear be repaired by arthroscopy? Yes. Many tears of the triangular fibrocartilage complex (TFCC) can be trimmed or stitched arthroscopically, through the same small incisions used to diagnose them. Whether a tear is trimmed or repaired depends on its position and type — tears near the outer edge have a good blood supply and are repaired, while tears in the central cushion are usually trimmed.
How soon can I drive after wrist arthroscopy? Driving after wrist arthroscopy is usually possible within one to two weeks after a diagnostic procedure, once the wrist grips and rotates comfortably and an emergency stop can be performed without pain. After a repair held in a splint or cast, driving waits until the splint is removed and a secure grip returns, which may be six weeks or more.
What is the difference between an MRI scan and wrist arthroscopy? An MRI scan is a non-invasive image that can suggest a tear or an abnormality, while wrist arthroscopy is a keyhole operation that shows the inside of the joint directly and allows treatment at the same time. An MRI is usually done first. Arthroscopy is more accurate for small tears and has the advantage of repairing the problem in the same procedure.
Is wrist arthroscopy suitable for wrist arthritis? Wrist arthroscopy has a limited role in arthritis. It can be used to wash out the joint, trim rough cartilage or remove loose fragments, which sometimes eases pain in earlier arthritis. Advanced arthritis, where the joint surfaces are worn through, generally needs an open procedure, so the suitability of arthroscopy is judged from the X-rays and the examination.
Mr Gavin Schaller FRCS(Tr&Orth), Consultant Hand & Wrist Surgeon The Schaller Hand & Wrist Clinic About Mr Schaller
This article is for general information only and is not a substitute for a consultation with a qualified clinician. If you have concerns about your hand or wrist, please seek medical advice.
