Indications:
This procedure is indicated for a number of problems within the wrist joint. Common indications are for scapholunate instability, DRUJ instability ganglion excision and TFCC debridement or repair. The indications for key hole surgery are expanding and now include more complex procedures. Very rarely it is performed as a diagnostic procedure to have a look at the structures within the native or artificial joint and maybe to take samples of the joint lining (synovium). Rarely it may be to wash out the joint in case of an infection and take samples of pus and tissue for culture.
What to expect before surgery
If you are to undergo this procedure with Dr Bala you will usually consult a member from the anaesthetic team a few days prior to the surgery. You may be required to bring some of your more recent investigations including a chest x-ray, ECG and routine blood tests and old x-rays, CT scans and MRI reports. If required the nurse or physician may order more tests if required. The procedure is usually performed under general anaesthesia The anaesthetist may further discuss these with you. The procedure and anaesthesia are usually for an hour or 2. Most wrist arthroscopies are day surgery procedures meaning you will usually go home the same day should you be well. Rarely if required you may have to stay overnight till, you’re more comfortable the next morning.
The nurse will instruct you on the time you should start fasting prior to the surgery start time, the reporting time into the hospital and the possible discharge time. It is a good idea to shower the night before surgery and remove jewellery at home.
On the day of surgery
It is good to report a couple of hours prior to the scheduled operation time to enable time for you to change into the hospital gown and be reviewed by the anaesthetist and the surgeon. The only prick you might feel is that of the IV line prior to anaesthesia. A ‘timeout’ is done to ensure that the entire team is satisfied with the side, procedure and equipment. The anaesthetist will give you some sleep medicines 1st to make you comfortable and you may request for your choice of music as drowse off to sleep. An IV antibiotic (usually cefazolin) is administered prior to surgical incision.
Surgery
Anaesthesia is usually given on the operating table. An ordinary table with attachments to position the wrist and hand in traction is used. The procedure is done with you either lying on your back. Dr Bala prefers finger traps or any commercially available wrist traction device (‘Spider’/ ‘Trimano”). Once you are comfortably positioned on the operating table with adequate cushioning and the operating side is cleaned and draped the procedure is begun. The wrist joint is entered through the back with a 30 deg 2.7 mm camera with light source while the joint is dry or irrigated with water or normal saline. Dr Bala may also use a shaver to clean loose tissue within the joint or a radiofrequency or diathermy probe to cut and remove similar such tissue. The definitive procedure is then performed. Multiple such small keyholes are made as required around the circumference of the wrist (usually 2 or3). At the end of the procedure the joint is irrigated and emptied. On occasion Dr Bala may choose to perform a part of the procedure open and which may involve a small wound on the back or side or both. Dr Bala closes the small keyholes with steristrips or a non-absorbable suture. As the wrist joint and the surrounding area is usually distended by the irrigation fluid, the area is cleaned and a compressive waterproof dressing is applied to soak up the ooze. A partial plaster splint and collar and cuff sling is usually provided to support the wrist after surgery. The drapes are removed and you will be shifted back to the trolley from the operating table after the procedure is complete.
For more details of specific procedures performed you may visit the following pages of this website
Wrist sprain or dislocation https://pradeepbala.com/conditions-treated/wrist-sprain-or-dislocation/
Carpal tunnel syndrome https://pradeepbala.com/conditions-treated/carpal-tunnel-syndrome/
Ganglion https://pradeepbala.com/conditions-treated/ganglion/
Wrist and hand arthritis https://pradeepbala.com/conditions-treated/wrist-and-hand-arthritis/
After surgery
You are usually kept in the observation bay in the operating theatre for a couple of hours and may either be shifted to the ward or discharged directly from the theatre. Once you are fully awake, have had a few sips of water without throwing up, can move all of your fingers comfortably without pain you may be discharged.
Dr Bala may either phone your closest relative or see you before you are discharged.
Follow up
You will be allowed to wipe the operated arm with a wet towel on the following day and will be allowed to shower a couple of days after the surgery ensuring the plaster wrist or hand are kept dry. The physiotherapist will instruct you to as to what movements you can and cannot do after surgery. Dr Bala sees his post op patients at around 2 weeks after surgery. There maybe a few sutures to remove. You may require some sessions of physiotherapy after surgery to optimize the function of your wrist.
