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Hand & Wrist Videos: Other
Endoscopic Ganglionectomy of the Volar Radial Wrist Ganglion
Volar ganglion cyst of the wrist is a common hand problem faced by orthopaedic surgeons. Excision is indicated if it is painful. Arthroscopic ganglionectomy of the wrist ganglion has been reported with the advantage of minimally invasive surgery. Most of them involve elimination of the valvular mechanism and internal drainage of the ganglion fluid to the wrist joint. The access of the ganglion sac is limited especially for a multiloculated cyst. The purpose of this Technical Note is to report the technique of endoscopic resection of the volar radial wrist ganglion.Endoscopic Ganglionectomy of Palmar Ganglion via Flexor Carpi Radialis Tendoscopy
Palmar ganglion is rare. Deep palmar ganglion usually arises from the wrist joint and may cause compression neuropathy. Superficial palmar ganglion may arise from the flexor tendons of the wrist. The chance of compression neuropathy is expected to be less than deep palmar ganglion. However, there is a higher chance of perforation through the skin and the ganglion may affect hand grip. Open resection of the ganglion does not require extensive deep soft tissue dissection. However, the skin incision can still be extensile to trace the stalk to the tendon of origin.Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Valgus Deformity
Arthrodesis of the first metatarsophalangeal joint is indicated for hallux valgus associated with degenerative changes, severe deformity, or rheumatoid arthritis and those for whom primary hallux valgus surgery has failed. Open approach requires extensive soft tissue dissection. The purpose of this Technical Note was to report the details of arthroscopic arthrodesis of the first metatarsophalangeal joint in severe and rigid hallux valgus deformity. This is a combination of endoscopic lateral release of the first metatarsophalangeal joint and arthroscopic arthrodesis of the joint.Endoscopic Decompression of a Gouty Tophus at the Hand Dorsum
Medical treatment including lifestyle and dietary modifications and drug therapy remains the mainstay of treatment for gouty arthritis of the hand and wrist. Without proper and timely treatment, tophi develop approximately 10 years after the onset of the disease. Open surgery for tophaceous gout is associated with a relatively high rate of complications particularly related to the surgical wound and overlying skin necrosis. Intralesional shaving of the tophi through small incisions has been reported and has the advantage of fewer wound complications.Dry Arthroscopic Excision of Dorsal Wrist Ganglion
Ganglions are common soft tissue masses of the hand. High recurrence rates are associated with nonsurgical treatment; thus, excision is often indicated. Arthroscopic excision and open excision have similar recurrence rates; however, the latter is associated with prolonged healing time and increased scarring. Recently, dry wrist arthroscopic techniques have been used. This technique allows easier confirmation of complete ganglion removal, easier conversion to open surgery, earlier return of motion, and stitch-less closure when compared with traditional “wet” arthroscopic excision.Flexor Pollicis Longus Tendoscopy
The deep palmar spaces of the hand include the midpalmar space, the hypothenar space, the thenar space, space of Parona, and the interdigital web spaces. There are various communications between different spaces. These communications are of clinical importance in explaining the spread of inflammatory, infectious, and even neoplasic processes that involve this region. Surgical incision and drainage of all potentially communicating spaces and compartments is mandatory in deep hand infections. The purpose of this technical note is to describe the minimally invasive approach of endoscopic drainage and debridement of the flexor pollicis longus tendon sheath, radial bursa, and thenar space.Arthroscopic Interphalangeal Arthrodesis of the Thumb
Arthrodesis of the interphalangeal joint of the thumb is an effective treatment for pain, deformity, or instability at the joint. Arthroscopic interphalangeal arthrodesis of the thumb is a minimally invasive surgery and has better cosmetic results and less surgical trauma as compared with the open approaches. The purpose of this technical note is to report the details of the arthroscopic interphalangeal arthrodesis with oblique placement of the headless screw. No traction device is used for this technique.Extensor Tendoscopy of the Wrist
Extensor tenosynovitis of the wrist can lead to rupture of the extensor tendons. Extensor tenosynovectomy is indicated if the tenosynovitis cannot be controlled by conservative measures. Open tenosynovectomy requires extensive dissection of soft tissue, including the extensor retinaculum. This article describes extensor tendoscopy of the wrist. This technique allows approach to the extensor compartments with small incisions and minimal soft tissue dissection. It is indicated when extensor tenosynovitis persists despite adequate medical treatments including medications, immobilization, and steroid injection.Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone
Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament.Direct “Cystoscopic” Approach for Arthroscopic Decompression of an Intraosseous Ganglion of the Lunate
Intraosseous ganglion cysts (IOGs) are uncommon lesions of the carpal bones and can present with persistent pain and stiffness of the wrist. Surgical decompression is recommended, and a variety of approaches to decompress symptomatic IOGs of the wrist have been described. We describe an arthroscopic approach that can be performed with only 2 portals and offers excellent access for visualization and instrumentation. The procedure involves creating a 3.2-mm tunnel into the lunate cyst; this is performed through the dorsal non-articular surface of the lunate, under direct vision, and the position is confirmed with fluoroscopy.The Spin Move: A Reliable and Cost-Effective Gowning Technique for the 21st Century
Operating room efficiency (ORE) and utilization are considered one of the most crucial components of quality improvement in every hospital. We introduced a new gowning technique that could optimize ORE. The Spin Move quickly and efficiently wraps a surgical gown around the surgeon's body. This saves the operative time expended through the traditional gowning techniques. In the Spin Move, while the surgeon is approaching the scrub nurse, he or she uses the left heel as the fulcrum. The torque, which is generated by twisting the right leg around the left leg, helps the surgeon to close the gown as quickly and safely as possible.Arthroscopic Reduction of Complex Dorsal Metacarpophalangeal Dislocation of Index Finger
Complex dorsal dislocation of the metacarpophalangeal joint is an uncommon injury, typically caused by entrapment of the volar plate within the joint space. Closed reduction of the dislocation is not effective; instead, open reduction is necessary to release the soft tissues interposed between the metacarpal head and the proximal phalanx. However, an operative risk of digital nerve injury exists because of intricate displacement of the normal anatomy. We successfully reduced a dislocation by arthroscopic release of the entrapped volar plate.Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome
Ulnar impaction syndrome is abutment of the ulna on the lunate and triquetrum that increases stress and load, causing ulnar-sided wrist pain. Typically, ulnar-positive or -neutral variance is seen on a posteroanterior radiograph of the wrist. The management of ulnar impaction syndrome varies from conservative, symptomatic treatment to open procedures to shorten the ulna. Arthroscopic management has become increasingly popular for management of ulnar impaction with ulnar-positive variance of less than 3 mm and concomitant central triangular fibrocartilage complex tears.Sonography-Assisted Arthroscopic Resection of Volar Wrist Ganglia: A New Technique
Although satisfactory arthroscopic resection of volar wrist ganglia has been reported recently, the risk of damage to arteries, nerves, and tendons remains. Furthermore, ganglia and their stalks cannot be visualized arthroscopically in many cases, and surgeons must perform a blind resection of the joint capsule until ganglion cysts or their stalks appear. Sonography has limited resolution, but recent improvements in hardware and software have made it an excellent noninvasive and dynamic imaging technique for assessing the musculoskeletal system.
