Arch Hand Microsurg.  2023 Jun;28(2):67-74. 10.12790/ahm.22.0073.

Arthroscopic synovectomy of the wrist

• Lee YK
• Kim JH

• KMID: 2542556
• DOI: http://doi.org/10.12790/ahm.22.0073

Abstract

The theoretical rationale of synovectomy is to reduce or eliminate the aggressive inflammatory cell mass, thereby reducing swelling, decreasing pain, and improving joint function. Traditionally, open-wrist synovectomy is the standard treatment, as it allows an inspection of all compartments and extensor tendons. Arthroscopic synovectomy of the wrist was first introduced by Roth and Poehling in 1990. Since then, it has been successfully performed in selected patients. Arthroscopic synovectomy might be indicated in any disease that leads to long-standing synovitis of the wrist and when other treatment modalities do not provide satisfactory symptom reduction or may be contraindicated. Arthroscopic synovectomy is a surgical procedure with minimal morbidity. It results in less damage to the joint capsule and ligaments, thereby hastening rehabilitation and shortening the hospital stay. Therefore, we think that understanding the surgical technique for wrist arthroscopic synovectomy and appropriately applying it to patients could prevent disease progression in patients with wrist arthritis and overcome incapacitating dysfunction of the upper limb, including the wrist, hand, and forearm.

Keyword

Wrist; Arthritis; Arthroscopy; Synovectomy

Figure

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  Fig. 1. Traction power in a rheumatoid arthritis patient. Given the laxity of the wrist and finger joint ligaments and frail skin, it is sufficient if the traction power is maintained below 10 lbs (approximately 4.5 kg).

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  Fig. 2. Portals for basic wrist arthroscopic synovectomy. MCU, midcarpal ulnar; MCR, midcarpal radial.Written informed consent was obtained from the patient for using clinical images.

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  Fig. 3. Synovitis of the radiocarpal joint dorsal aspect (A). Arthroscope placed in the 6R portal and the shaver placed in the 3/4 or 4/5 portal to remove synovial tissue (B), performing synovectomy using a shaver (C).Written informed consent was obtained from the patient for using clinical images.

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  Fig. 4. Performing distal radioulnar joint synovectomy using a shaver through the 6R portal with the arthroscope placed in the 4/5 portal.

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  Fig. 5. Removing the synovitis of the midcarpal joint dorsal aspect with the arthroscope placed in the accessory portal and the shaver in the midcarpal ulnar portal (A). (B) Performing synovectomy using a shaver.Written informed consent was obtained from the patient for using clinical images.

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  Fig. 6. Radiocarpal joint synovitis in a rheumatoid arthritis patient.

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  Fig. 7. Midcarpal joint synovitis in a rheumatoid arthritis patient. (A) Synovitis in the volar side of the scapho-lunate joint and midcarpal joint. (B) Synovitis in the volar side of the luno-triquetral joint and midcarpal joint. Ca, capitate; Sc, scaphoid; Lu, lunate; MCU, midcarpal ulnar; Tq, triquetrum.

Reference

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