Wrist arthroscopy is performed with the patient in the supine position and the arm
resting on the hand table. The distal half of the arm must lie on the table and this is
where the tourniquet is applied. Immobilization of the arm depends on the traction
device that will be used. In general there either standalone traction devices that can
be sterilized #F or traction is applied through a shoulder crane which is attached to
the opposite side of the hand table the level of the patient’s waist #F. Some
standalone devices offer the possibility of slight wrist flexion during the procedure
which can be advantageous. It is preferable the traction is applied at an angle slightly
away from the operating surgeon who is seated next to the patient’s head.

Traction is conferred to the wrist through the fingers traps (“chinese fingers”). In
recent years nylon mesh finger traps have replaced metal mesh finger traps and the
rate of neuropraxia of the digital nerves and skin lesions to the fingers have
decreased substantially. It is, however, important to use finger traps in all fingers if
possible and to make sure that tension is applied evenly to the finger traps.

Our prefered set up is with the shoulder crane on the opposite side and an ISI( ?/)
traction device. This offers the advantage 360° access to the wrist and the possibility
to obtain fluoroscopic images with a mini c-arm while in traction.

The appropriate arthroscope for wrist arthroscopy is a 2.7mm outer diameter 2.3mm
or 2.4mm inner diameter short length 30° arthroscope #F. It should be noted that the
2.7 mm long arthroscope for the ankle joint is not appropriate for wrist arthroscopy
because of the long level arm which multiplies the movement of the surgeon. On that
same note the 1.9 mm arthroscopes are best suited for finger joint arthroscopy and
do not provide a large enough field of view for the wrist. The classic 4mm
arthroscopes used in the knee, shoulder and hip are innapropriate for wrist
arthrocopy.

Recently, a 1.9 mm arthroscopy system with a wider field of view (Nanoscope,
Arthrex ??) was introduced, together with appropriate instrumentation. This is a
straight system meaning there is no 30° angulation of the optical system which

permits better navigation in the joint. It is currently used mostly for the diagnostic
purposes but it’s operative use remains limited.
Other than the arthroscope, appropriate small instruments are needed including mini
punches, graspers and probes. Also mechanized resectors (shavers) of 2.4mm to
3.5mm are used as well as mini (2.5mm-3.5mm) radiofrequency probes either
monopolar or bipolar. Regarding the radiofrequency probes, it should be kept in mind
that they can produce substantial temperature rise in a small joint, especially if
there's no outflow. It is advisable they are used in the lowest temperature setting,
that they are applied intermittently for a few seconds at a time and that there is
sufficient outflow at all times.

Wrist arthroscopy can be performed with gravity inflow and outflow however most
modern arthroscopy pumps have small joint settings and this can facilitate
performance. It is advisable not to manually raise the pump pressure over 50 mm Hg
especially cases of distal radius fractures, where fluid can escape through the
fracture lines and cause compartment syndrome of the forearm.In distal radius
fracture cases is advisable that an elastic bandage is used around the forearm to
decrease fluid escape.