Arthroscopic Wrist Capsulotomy

Published on 11/04/2015 by admin

Filed under Orthopaedics

Last modified 11/04/2015

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CHAPTER 19 Arthroscopic Wrist Capsulotomy

Indications

A biomechanical study performed by Palmer et al. defined functional wrist motion as being flexion of 5 degrees, extension of 30 degrees, radial deviation of 15 degrees, and ulnar deviation of 10 degrees.6 Patients lacking a functional arc of wrist motion who have failed a trial of dynamic/static progressive splinting are candidates for this procedure. Volar capsulotomies are less risky and are indicated to regain wrist extension. Dorsal capsulotomies are necessary to regain wrist flexion but they may require use of a volar arthroscopy portal and are technically more difficult.

Surgical Technique

Volar Capsulotomy

The procedure is done under tourniquet control. A 3−/,4 portal and 4−/,5 portal are established as described in Chapter 1. Inflow through the scope with outflow through a cannula in the 6–R portal is standard, although it may be necessary to switch in cases where adhesions block the flow. The radiocarpal joint space is identified with a 22–gauge needle and the joint is inflated with saline. A contracted joint may accept only a small amount of fluid.

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