Wrist Arthroscopy
William B. Geissler, MD
Professor and Chief, Arthroscopy and Sports Medicine Professor, Division of Hand and Upper Extremity Surgery Director, Hand/Upper Extremity Fellowship Program Department of Orthopaedic Surgery and Rehabilitation University of Mississippi Medical Center
Jackson, Mississippi
Editor
Wrist Arthroscopy
Foreword by Terry L. Whipple, MD, FACS
With 217 Illustrations in 321 Parts, 44 in Full Color
William B. Geissler, MD
Professor and Chief, Arthroscopy and Sports Medicine Professor, Division of Hand and Upper Extremity Surgery Director, Hand/Upper Extremity Fellowship Program Department of Orthopaedic Surgery and Rehabilitation University of Mississippi Medical Center
Jackson, MS 39216 USA
Library of Congress Cataloging-in-Publication Data Wrist arthroscopy / [edited by] William Geissler.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-387-20897-6 (h/c : alk. paper)
1. Wrist—Endoscopic surgery. 2. Wrist—Surgery. 3. Arthroscopy. I. Geissler, William.
[DNLM: 1. Wrist—surgery. 2. Arthroscopy—methods. WE 830 W95512 2004]
RD559.W7514 2004
617.5⬘74—dc22 2004041828
ISBN 0-387-20897-6 Printed on acid-free paper.
© 2005 Springer Science⫹Business Media, Inc.
All rights reserved. This work may not be translated or copied in whole or in part without the writ- ten permission of the publisher (Springer Science⫹Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer soft- ware, or by similar or dissimilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of go- ing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
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Foreword
It is a great pleasure to introduce this techniques book and accompanying DVD on arthroscopic surgery of the wrist. Dr. William B. Geissler, uniquely qualified to address the diagnosis and treatment of wrist disorders, has devoted himself to teaching others the advantages and techniques of applying minimally invasive surgical approaches to this complex joint. He has assembled an impressive team of accomplished contributors; thus the reader will find it enjoyable, informative and particularly thorough as a reference for hand surgery.
Dr. Geissler has organized the text and DVD to the practitioner’s advantage.
Arthroscopic anatomy is discussed in detail. Specific diagnoses are addressed sep- arately throughout. Newer technologies such as laser energy and electrothermal devices are addressed to illuminate their potential application in the wrist.
Arthroscopy has provided new, minimally invasive access to smaller joints as well. The distal radioulnar joint of the wrist and even the carpometacarpal joint of the thumb can now be evaluated and surgically treated in many cases by arthroscopy.
For those who are looking to master the newer surgical approaches to the hand and wrist, or for those seeking guidance for a specific surgical procedure for the wrist, this book, with an accompanying DVD, constitutes an excellent source. It surely represents the current state of the art for arthroscopic surgery of the wrist.
Terry L. Whipple, MD, FACS
v
Preface
Arthroscopy has revolutionized the practice of orthopedics by providing the technical capability to examine and treat intra-articular abnormalities di- rectly. The development of wrist arthroscopy was a natural evolutionary progression from the successful application of arthroscopy to other, larger joints.
The wrist is a labyrinth of eight carpal bones and multiple articular surfaces, with both intrinsic and extrinsic ligaments and a triangular fibrocartilage complex—
all within a 5-cm interval. This perplexing joint continues to challenge clinicians with an array of potential diagnoses and treatments. Wrist arthroscopy has sig- nificantly advanced our knowledge and understanding of this complex joint. This is an exciting time in the field; there has been considerable growth since pioneers, such as Terry L. Whipple, MD, Gary Poehling, MD, and A. Lee Osterman, MD, reported their original descriptions of the techniques they developed from re- viewing the anatomy of the wrist.
The indications and techniques for wrist arthroscopy have continued to ex- pand since Terry L. Whipple wrote his original textbook on arthroscopic surgery of the wrist approximately 12 years ago. Much has changed as more surgeons have been exposed to wrist arthroscopy and have contributed to the field, and as ar- throscopy has been applied to the thumb and smaller joint areas of the hand.
This is truly an international text. Recognized experts from around the world have contributed their latest techniques and advances in wrist arthroscopy. These authors describe their arthroscopic techniques in detail and include tips and tricks to make the procedure easier for all of us to perform. This book and DVD con- tain updates on commonly performed wrist arthroscopy procedures, such as de- bridement of tears of the triangular fibrocartilage complex (TFCC) and manage- ment of carpal instability and distal radius fractures. It also includes the very latest descriptions of arthroscopic management of acute scaphoid fractures and selected nonunions, including arthroscopic bone grafting, arthroscopic excision of both volar and dorsal wrist ganglia, new techniques in arthroscopic repair of peripheral TFCC tears, and the application of arthroscopy and debridement to arthrofibrosis of the wrist.
This book, with an accompanying DVD is intended for the surgeon who is just beginning to develop an interest in wrist arthroscopy, as well as for the ex- perienced arthroscopist who wants to refresh his memory before performing a spe- cific arthroscopic procedure. Subjects for the beginner include how to evaluate the painful wrist; when to order imaging studies and which studies are appro- priate; understanding the complexities and mechanics of carpal instability; and general arthroscopic anatomy and setup. Complex topics such as arthroscopic proximal carpectomy, electrothermal shrinkage, and arthroscopy of the thumb carpometacarpal joints and the small joints of the hand are discussed in detail for the wrist arthroscopy expert.
ACKNOWLEDGMENTS
I would like to acknowledge a number of those who have contributed to this text- book. First, I would like to thank Terry L. Whipple, MD, who initially exposed me to the techniques of wrist arthroscopy. He demonstrated to me how precise and delicate arthroscopic surgery of the wrist is expertly performed. Next, thanks to Alan E. Freeland, MD, my mentor, friend, and colleague, who continues to in- v i i
struct me in hand surgery and guide my career. Thanks also to Janis Freeland, RN, my nurse, and Tammy Chamblee, her assistant, who really run the show;
Susan Fleming, who tirelessly works to keep things organized for me; Patti Corder, RN, Margie Ross, RN, Tracy Wall, RN, and Macy Gunter, ORT, and the other surgical nurses at the Methodist Rehabilitation Center and University Medical Center, who work long hours in the operating room. I also very much want to thank Merry Post for her excellent command of the English language and her con- stant, gentle reminders to finish the textbook—onward and upward. Thank you to Susan and Rachel Leigh, who have taught me strength and courage and every once in a while to take time to stop and smell the roses. Special thanks go to Stryker Endoscopy and Acumed Corporation for their generous support for the DVD. Most of all, I want to thank my national and international experts for shar- ing their latest techniques with us so that we all may continue to advance in the field of wrist arthroscopy.
William B. Geissler, MD
v i i i P R E F A C E
Contents
Foreword by Terry L. Whipple . . . v
Preface . . . vii
Contributors . . . xi
1 General Anatomy and Setup . . . 1
Thomas B. Hughes, Jr., and Arnold-Peter C. Weiss 2 Arthroscopic Wrist Anatomy . . . 7
Jonathan H. Lee, Nathan L. Taylor, Ryan A. Beekman, and Melvin P. Rosenwasser 3 Evaluation of the Painful Wrist . . . 15
Karl Michalko, Scott Allen, and Edward Akelman 4 Lasers and Electrothermal Devices . . . 22
Daniel J. Nagle 5 Repair and Treatment of TFCC Injury . . . 31
James Chow 6 Repair of Peripheral Ulnar TFCC Tears . . . 36
Sanjay K. Sharma and Thomas E. Trumble 7 Repair of Peripheral Radial TFCC Tears . . . 42
William B. Geissler and Walter H. Short 8 Management of Type C TFCC Tears . . . 50
Matthew M. Tomaino 9 Debridement of Central TFCC Tears . . . 55
Gary R. Kuzma and David S. Ruch 10 Arthroscopic Management of Ulnar Impaction Syndrome . . . 63
Gregory J. Hanker 11 Kinematics and Pathophysiology of Carpal Instability . . . 72
Alan E. Freeland and William B. Geissler 12 Management of Scapholunate Instability . . . 86
William B. Geissler 13 Management of Lunotriquetral Instability . . . 94
Michael J. Moskal and Felix H. Savoie III 14 Management of Distal Radial Fractures . . . 102
Tommy Lindau 15 Fixation of Acute and Selected Nonunion Scaphoid Fractures . . . 112
Joseph F. Slade III, Greg A. Merrell, and William B. Geissler
i x
16 Management of Articular Cartilage Defects . . . 125 Christophe Mathoulin and Susan Nasser-Sharif
17 Radial Styloidectomy . . . 134 David M. Kalainov, Mark S. Cohen, and Stephanie Sweet
18 Excision of Dorsal Wrist Ganglia . . . 139 William B. Geissler
19 Wrist Arthrolysis . . . 145 Riccardo Luchetti, Andrea Atzei, and Tracy Fairplay
20 Small-Joint Arthroscopy in the Hand and Wrist . . . 155 Richard A. Berger
21 Proximal Row Carpectomy . . . 167 Matthew A. Bernstein and Randall W. Culp
22 Trapeziectomy with Thermal Capsular Modification . . . 170 Scott G. Edwards and A. Lee Osterman
23 Resection of Volar Ganglia . . . 182 Christophe Mathoulin
24 Clinical Approach to the Painful Wrist . . . 185 Andrea Atzei and Riccardo Luchetti
Index . . . 197
x C O N T E N T S
Contributors
Edward Akelman, MD
Professor and Vice-Chairman, Department of Orthopaedics, Brown Medical School; Chief, Division of Hand/Upper Extremity and Microvascular Surgery, Rhode Island Hospital, Providence, RI, 02905, USA
Scott Allen, MD
Clinical Instructor, Department of Orthopaedics, Brown Medical School, Providence, RI 02905, USA
Andrea Atzei, MD
Associate Professor of Hand Surgery and Reconstructive Microsurgery, Clinical Coordinator, Hand Surgery Unit, Department of Orthopaedic Surgery, Univer- sity of Verona, 37100 Verona, Italy
Ryan A. Beekman, MD
Fellow, Hand and Microvascular Surgery, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York Presby- terian Hospital, New York, NY 10032, USA
Richard A. Berger, MD, PhD
Professor, Department of Orthopaedic Surgery and Anatomy, Mayo Graduate College of Medicine; Consultant in Hand and Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
Matthew A. Bernstein, MD
Berrington Orthopaedic Specialists, Hoffman Estates, IL 60195, USA James Chow, MD
Director, Orthopaedic Center of Southern Illinois, Clinical Assistant Professor, Southern Illinois University School of Medicine, Mt. Vernon, IL 62864, USA Mark S. Cohen, MD
Associate Professor of Hand, Wrist, and Elbow Surgery, Department of Orthopaedics, Rush Medical Center, Midwest Orthopaedics, Chicago, IL 60612, USA
Randall W. Culp, MD
Associate Professor of Orthopaedic, Hand, and Microsurgery, Thomas Jefferson University, King of Prussia, PA 19078, USA
Scott G. Edwards, MD
Associate Professor, Orthopaedic Surgery, Georgetown University, Alexandria, VA 22310, USA
Tracy Fairplay, PT
Private Professional Hand Therapy Practice, Bologna, Italy; Hand Therapy Consultant, Department of Functional Rehabilitation and Hand Surgery, Policlinico di Moderna, 40137 Bologna, Italy
x i
Alan E. Freeland, MD
Professor of Hand and Wrist Surgery, Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS 39216, USA
William B. Geissler, MD
Professor and Chief, Arthroscopy and Sports Medicine, Professor, Division of Hand and Upper Extremity Surgery, Director, Hand/Upper Extremity Fellowship Program, Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS 39216, USA
Gregory J. Hanker, MD
Assistant Clinical Professor of Plastic and Reconstructive Surgery, University of Southern California, Southern California Orthopaedic Institute, Van Nuys, CA 91405, USA
Thomas B. Hughes, Jr., MD
Clinical Instructor, Orthopaedic Surgery, Drexel University School of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA David M. Kalainov, MD
Assistant Director, Clinical Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Northwestern Center for Orthopaedics, Chicago, IL 60611, USA
Gary R. Kuzma, MD
Clinical Associate Professor, Hand Center of Greensboro, Bowman Gray School of Medicine, Greensboro, NC 27405, USA
Jonathan H. Lee, MD
Research Fellow, Trauma Training Center, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY 10032, USA
Tommy Lindau, MD, PhD
Assistant Professor of Orthopaedic Surgery, Hand Unit, Department of Orthopedics, Lund University Hospital, 22185 Lund, Sweden
Riccardo Luchetti, MD
Associate Professor, Clinic of Plastic, Reconstructive and Hand Surgery, Ancona University, Torrette Hospital; Department of Orthopaedics, Trauma- tology and Surgery of the Hand, State Hospital, Republic of San Marino, 47900 Rimini, Italy
Christophe Mathoulin, MD
Head, Hand and Microsurgery Department, Hospital Tenon, Institut de la Main, 75016 Paris, France
Greg A. Merrell, MD
Chief Resident, Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, CT 06519, USA
Karl Michalko, MD
Assistant Professor, Department of Microsurgery, Plastic Surgery Division, University of Rochester, Rochester, NY 14627, USA
x i i C O N T R I B U T O R S
Michael J. Moskal, MD
Clinical Instructor, Department of Orthopaedic Surgery, University of Washington, New Albany, IN 47150, USA
Daniel J. Nagle, MD
Professor, Clinical Orthopaedic Surgery, Northwestern University Medical School, Chicago, IL 60611, USA
Susan Nasser-Sharif, MD
Resident, Orthopaedic Surgery, Institut de la Main, 75016 Paris, France A. Lee Osterman, MD
Professor of Orthopaedic and Hand Surgery, Chairman, Division of Hand Surgery, Thomas Jefferson University, King of Prussia, PA 19078, USA Melvin P. Rosenwasser, MD
Robert E. Carroll Professor of Orthopaedic Surgery, Director of Hand and Orthopaedic Trauma Service, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY 10032, USA David S. Ruch, MD
Associate Professor, Department of Orthopaedic Surgery, Co-Director, Hand Surgery Fellowship, Wake Forest University, Winston-Salem, NC 27157, USA Felix H. Savoie III, MD
Clinical Associate Professor, Department of Orthopaedic Surgery, University of Mississippi Medical Center; Co-director, Upper Extremity Service, Mississippi Sports Medicine Orthopaedic Center, Jackson, MS 39202, USA Sanjay K. Sharma, MD
Hand Fellow, Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA
Walter H. Short, MD
Clinical Research Professor, Orthopedics, State University of New York Upstate Medical Institute for Human Performance, Syracuse, NY 13202, USA Joseph F. Slade III, MD
Associate Professor of Orthopaedics and Rehabilitation, Director, Yale Hand and Upper Extremity Center, Yale University School of Medicine, New Haven, CT 06519, USA
Stephanie Sweet, MD
Clinical Assistant Professor, Department of Orthopaedic Surgery, Thomas Jefferson University, King of Prussia, PA 19078; Philadelphia Hand Center, Philadelphia, PA 19107, USA
Nathan L. Taylor, MD
Fellow, Hand and Microsurgery, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY 10032, USA
Matthew M. Tomaino, MD
Chief of Microsurgery, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
C O N T R I B U T O R S x i i i
Thomas E. Trumble, MD
Professor, Orthopaedic Surgery, Chief, Hand and Microvascular Surgery Service, University of Washington, Seattle, WA 98195, USA
Arnold-Peter C. Weiss, MD
Professor, Hand/Elbow Surgery and Microvascular Surgery, Department of Orthopaedic Surgery, Brown Medical School, Providence, RI 02905, USA
x i v C O N T R I B U T O R S
