Arthroscopy of the Wrist: Clinical Implications and Future Prospects

Abstract

This thesis explores the role of wrist arthroscopy in the diagnosis and treatment of traumatic and non-traumatic wrist disorders, with a focus on patient-reported outcomes, complications, and subsequent interventions. Both established arthroscopic techniques and innovative applications are examined for a number of common wrist pathologies. Chapter 2 reviews recent developments in wrist arthroscopy, outlining arthroscopic techniques and their clinical value. Evidence shows that wrist arthroscopy is more sensitive than MRI for diagnosing triangular fibrocartilage complex (TFCC) and scapholunate ligament (SLL) injuries, supporting its use in patients with persistent post-traumatic wrist pain. Arthroscopic treatment of TFCC injuries results in better functional outcomes and fewer complications than open surgery, while arthroscopic ganglionectomy is associated with lower recurrence rates than open procedures. Chapter 3 reports an international survey among experienced wrist arthroscopists, demonstrating consensus that diagnostic outcomes depend strongly on surgeon experience and that wrist arthroscopy is superior to MRI for diagnosing traumatic TFCC and SLL injuries. However, considerable variation remains regarding treatment strategies. Chapter 4 uses Computer-Assisted Surgical Anatomy Mapping (CASAM) to map the distal posterior interosseous nerve (PIN) relative to wrist arthroscopy portals in cadaveric specimens. Despite notable interspecimen variability, safe distances to the 3–4 and 6R portals were observed, supporting the overall safety of wrist arthroscopy when performed carefully. Chapter 5 evaluates outcomes after arthroscopic treatment of symptomatic TFCC injuries in 51 patients. Acceptable wrist function was achieved, although approximately 20% required secondary surgery. Complications were minor and infrequent. Chapter 6 examines arthroscopic radial styloidectomy (ARS) for radioscaphoid impingement, primarily in early and late-stage SLAC and SNAC wrists. Long-term results showed sustained functional improvement and high patient satisfaction, despite a notable rate of secondary interventions. ARS is therefore recommended as a joint-preserving option before more invasive salvage procedures. Chapter 7 assesses arthroscopic ganglionectomy, demonstrating favourable functional outcomes, low recurrence rates, and a clear learning curve, supporting its use as an alternative to open surgery. Chapter 8 presents a systematic review showing that arthroscopic synovectomy in rheumatoid arthritis can improve pain and wrist function with few complications, although the quality of evidence is limited. Chapter 9 outlines the ongoing ARCTIC randomized controlled trial comparing arthroscopic synovectomy with intra-articular corticosteroid injections. Chapter 10 describes a pilot sub-study analyzing synovial tissue using single-cell RNA sequencing, revealing interpatient molecular heterogeneity that may enable personalized treatment selection. Together, these studies highlight the expanding diagnostic, therapeutic, and translational potential of wrist arthroscopy.