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Small Joint Arthroscopy

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Wrist and Elbow Arthroscopy

Abstract

The development of small and micro-arthroscopes has ushered in an era of small joint arthroscopy that remains in a state of progression. Despite these technological advances, clinical indications for small joint arthroscopy in the hand remain scant and underutilized. This is mainly due to a scarcity of papers utilizing this technique in the literature, as well as rare hands on training in the technical aspects of small joint arthroscopy. Despite the fact that these small joint arthroscopes have been readily available for decades, hand surgeons have been slow to adopt this methodology within their treatment protocols of both traumatic and degenerative conditions involving small joints.

This discussion will focus on small joints within the hand, namely the trapeziometacarpal, scaphotrapezial-trapezoidal, metacarpophalangeal, fifth carpometacarpal (CMC), proximal (PIP), and even distal (DIP) interphalangeal joints. Similar instrumentation is used in the temporomandibular joints and small foot articulations but is beyond the “scope” of this chapter.

Both traumatic and degenerative afflictions in the hand are ideally suited for use of small joint arthroscopy. Basic arthroscopic techniques such as synovectomy, debridement, chondroplasty, capsulorrhaphy, joint resurfacing, and arthroscopic-assisted internal fixation or soft tissue repairs are all ideally suited for the small joints. Further advances in fiberoptic technologies, and particularly in small joint instrumentation, will help contribute to expanding treatment options in articular pathology within the small joints.

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References

  1. Chen YC. Arthroscopy of the wrist and finger joints. Orthop Clin North Am. 1979;10(3):723–33.

    CAS  PubMed  Google Scholar 

  2. Gupta R, Bozentka DJ, Osterman AL. Wrist arthroscopy: principles and clinical applications. J Am Acad Orthop Surg. 2001;9(3):200–9.

    CAS  PubMed  Google Scholar 

  3. Badia A. Arthroscopy of the trapeziometacarpal and metacarpophalangeal joints. J Hand Surg Am. 2007;32(5):707–24.

    Article  PubMed  Google Scholar 

  4. Menon J. Arthroscopic management of trapeziometacarpal joint arthritis of the thumb. Arthroscopy. 1996;12:581–7.

    Article  CAS  PubMed  Google Scholar 

  5. Berger R. Arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg Am. 1998;23:757.

    Article  Google Scholar 

  6. Bettinger PC, Linscheid RL, Berger RA, Cooney WP, Kai-Nan A. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am. 1999;24:786–98.

    Article  CAS  PubMed  Google Scholar 

  7. Osterman AL, Culp R, Bednar J. Arthroscopy of the thumb carpometacarpal joint. Arthroscopy. 1997;13:3.

    Google Scholar 

  8. Badia A. Trapeziometacarpal arthroscopy: a classification and treatment algorithm. Hand Clin. 2006;22:153–63.

    Article  PubMed  Google Scholar 

  9. Weitbrecht J. Syndesmology. Philadelphia: WB Saunders; 1969. p. 1742.

    Google Scholar 

  10. Van Brenk B, Richards RR, Mackay MB, Boynton EL. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg Am. 1998;23:607–11.

    Article  PubMed  Google Scholar 

  11. Zancolli EA, Cozzi EP. The trapeziometacarpal joint: anatomy and mechanics. In: Zancolli E, Cozzi EP, editors. Atlas of surgical anatomy of the hand. New York: Churchill Livingstone; 1992. p. 443–4.

    Google Scholar 

  12. Xu L, Strauch RJ, Ateshian GA, et al. Topography of the osteoarthritic thumb carpometacarpal joint and its variation with regard to gender, age, site, and osteoarthritic stage. J Hand Surg Am. 1998;23:454.

    Article  CAS  PubMed  Google Scholar 

  13. Pelligrini VD. Pathomechanics of the thumb trapeziometacarpal joint. Hand Clin. 2001;17(2):175–84.

    Google Scholar 

  14. Bettinger PC, Berger RA. Functional ligamentous anatomy of the trapezium and trapeziometacarpal joint (gross and arthroscopic). Hand Clin. 2001;17(2):151–69.

    CAS  PubMed  Google Scholar 

  15. Orellana MA, Chow JC. Arthroscopic visualization of the thumb carpometacarpal joint: introduction and evaluation of a new radial portal. Arthroscopy. 2003;19(6):583–91.

    Article  PubMed  Google Scholar 

  16. Walsh EF, Akelman E, Fleming BC, DaSilva MF. Thumb carpometacarpal arthroscopy: a topographic, anatomic study of the thenar portal. J Hand Surg Am. 2005;30:373–9.

    Article  PubMed  Google Scholar 

  17. Slutsky D. The use of a dorsal-distal portal in trapeziometacarpal arthroscopy. Arthroscopy. 2007;23(11):1244.e1–4.

    Article  Google Scholar 

  18. Culp RW, Rekant MS. The role of arthroscopy in evaluating and treating trapeziometacarpal disease. Hand Clin. 2001;17(2):315–9.

    CAS  PubMed  Google Scholar 

  19. Massoud SN, Levy O, Copeland SA. Radiofrequency capsular shrinkage for voluntary shoulder dislocation. J Shoulder Elbow Surg. 2007;16(1):43–8.

    Article  PubMed  Google Scholar 

  20. Lubowitz JH, Poehling GG. Glenohumeral thermal capsulorrhaphy is not recommended—shoulder chondrolysis requires additional research. Arthroscopy. 2007;23(7):687.

    Article  PubMed  Google Scholar 

  21. Lopez MJ, Hayashi K, Fanton GS, Thabit G, Markel MD. The effects of radiofrequency energy on the ultrastructure of joint capsular collagen. Arthroscopy. 1998;14(5):495–501.

    Article  CAS  PubMed  Google Scholar 

  22. Hecht P, Hayashi K, Cooley AJ, Lu Y, Fanton GS, Thabit G, Markel MD. The thermal effect of monopolar radiofrequency energy on the properties of joint capsule. Am J Sports Med. 1998;26(6):808–14.

    CAS  PubMed  Google Scholar 

  23. Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3:455–71.

    CAS  PubMed  Google Scholar 

  24. Thompson JS. Suspensionplasty: trapeziometacarpal joint reconstruction using abductor pollicis longus. Operat Tech Orthop. 1996;6:98–105.

    Article  Google Scholar 

  25. Cobb T, Sterbank P, Lemke J. Arthroscopic resection arthroplasty for treatment of combined carpometacarpal and scaphotrapeziotrapezoid (pantrapezial). J Hand Surg Am. 2011;36(3):413–9.

    Article  PubMed  Google Scholar 

  26. Braun RM. Total joint replacement at the base of the thumb—preliminary report. J Hand Surg. 1982;7:245–51.

    Article  CAS  Google Scholar 

  27. Badia A, Sambandam SN. Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am. 2006;31(10):1605–14.

    Article  PubMed  Google Scholar 

  28. Goldfarb C, Stern P. Indications and technique for thumb carpometacarpal joint arthrodesis. Tech Hand Up Extrem Surg. 2002;6(4):178–84.

    Article  PubMed  Google Scholar 

  29. Badia A, Young L, Riano F. Bilateral arthroscopic tendon interposition arthroplasty of the thumb carpometacarpal joint in a patient with Ehlers-Danlos syndrome: a case report. J Hand Surg Am. 2005;30(4):673–6.

    Article  PubMed  Google Scholar 

  30. Gisselfält K, Edberg B, Flodin P. Synthesis and properties of degradable poly(urethane urea)s to be used for ligament reconstructions. Biomacromolecules. 2002;3:951–8.

    Article  PubMed  Google Scholar 

  31. Nilsson A, Liljensten E, Bergstrom C, Sollerman C. Results from a degradable TMC joint spacer (Artelon) compared with tendon arthroplasty. J Hand Surg Am. 2005;30(2):380–9.

    Article  PubMed  Google Scholar 

  32. Badia A. Arthroscopic indications for artelon interposition arthroplasty of the thumb trapeziometacarpal joint. Tech Hand Up Extrem Surg. 2008;12(4):1–6.

    Google Scholar 

  33. Kuhns CA, Meals RA. Hematoma and distraction arthroplasty for basal thumb osteoarthritis. Tech Hand Up Extrem Surg. 2004;8:2–6. Gervis simple resection.

    Article  PubMed  Google Scholar 

  34. Gervis HW. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint. J Bone Joint Surg Br. 1949;31:537–9.

    Google Scholar 

  35. Yao J. Suture-button suspensionplasty for the treatment of thumb carpometacarpal joint arthritis. Hand Clin. 2012;28(4):579–85.

    Article  PubMed  Google Scholar 

  36. Wilson JN. Basal osteotomy of the first metacarpal in the treatment of arthritis of the carpo-metacarpal joint of the thumb. Br J Surg. 1973;60:854–8.

    Article  CAS  PubMed  Google Scholar 

  37. Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease with thumb metacarpal extension osteotomy. J Hand Surg Am. 2000;25(6):1100–6.

    Article  CAS  PubMed  Google Scholar 

  38. Badia A, Khachandani P. Treatment of early basal joint arthritis using a combined arthroscopic debridement and metacarpal osteotomy. Techniques in Hand & Upper Extremity Surgery June. 2007;11(2):168–73.

    Article  Google Scholar 

  39. Buck-Gramcko D, Dietrich FE, Gogge S. Evaluation criteria in follow-up studies of flexor tendon therapy [in German]. Handchirurgie. 1976;8:65–9.

    CAS  PubMed  Google Scholar 

  40. Bettinger PC, Linscheid RL, Cooney 3rd WP, An KN. Trapezial tilt: a radiographic correlation with advanced trapeziometacarpal joint arthritis. J Hand Surg Am. 2001;26:692–7.

    Article  CAS  PubMed  Google Scholar 

  41. Barron OA, Eaton RG. Save the trapezium: double interposition arthroplasty for the treatment of stage IV disease of the basal joint. J Hand Surg Am. 1998;23:196–204.

    Article  CAS  PubMed  Google Scholar 

  42. Cobb T. Arthroscopic STT, arthroplasty. J Hand Surg Am. 2009;34 Suppl 1:42–3.

    Article  Google Scholar 

  43. Ashwood N, Bain G, Wardle N. STT scope. Results of Arthroscopic Debridement for Isolated Scapho-trapeziotrapezoidal Arthritis. Orthopaedic proceedings of JBJS (Br) 2008; 90-B (Supp I 3-4).

    Google Scholar 

  44. Bare J, Graham A, Tham S. Scaphotrapezial joint arthroscopy: a palmar portal. J Hand Surg Am. 2003;28:605–9.

    Article  PubMed  Google Scholar 

  45. Carro L, Golano P, Farinas O, Cereza L, Hidalgo C. The radial portal for scaphotrapeziotrapezoid. Arthroscopy. 2003;19(5):547–53.

    Article  PubMed  Google Scholar 

  46. Vaupel GL, Andrews JR. Diagnostic and operative arthroscopy of the thumb metacarpophalangeal joint. A case report. Am J Sports Med. 1985;13(2):139–41.

    Article  CAS  PubMed  Google Scholar 

  47. Wilkes LL. Arthroscopic synovectomy in the rheumatoid metacarpophalangeal joint. J Med Assoc Ga. 1987;76:638–9.

    CAS  PubMed  Google Scholar 

  48. Leclercq G, Schmitgen G, Verstreken J. Arthroscopic treatment of metacarpophalangeal arthropathy in haemochromatosis. J Hand Surg Br. 1994;19:212–4.

    Article  Google Scholar 

  49. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal ulnar collateral ligament tears. J Hand Surg Am. 1995;20:1037–42.

    Article  CAS  PubMed  Google Scholar 

  50. Rozmaryn LM, Wei N. Metacarpophalangeal arthroscopy. Arthroscopy. 1999;15:333–7.

    Article  CAS  PubMed  Google Scholar 

  51. Slade 3rd JF, Gutow AP. Arthroscopy of the metacarpophalangeal joint. Hand Clin. 1999;15:501–27.

    PubMed  Google Scholar 

  52. Wei N, Delauter SK, Erlichman MS, Rozmaryn LM, Beard SJ, Henry DL. Arthroscopic synovectomy of the metacarpophalangeal joint in refractory rheumatoid arthritis: a technique. Arthroscopy. 1999;15:265–8.

    Article  CAS  PubMed  Google Scholar 

  53. Sekiya I, Kobayashi M, Taneda Y, Matsui N. Arthroscopy of the proximal interphalangeal and metacarpophalangeal joints in rheumatoid hands. Arthroscopy. 2002;18:292–7. Badia bony gamekeeper.

    Article  PubMed  Google Scholar 

  54. Badia A, Riano F. Arthroscopic reduction and internal fixation for bony gamekeeper’s thumb. Orthopedics. 2006;29(8):675–8.

    PubMed  Google Scholar 

  55. Thompson M, Douglas G, Davison EP. Synovectomy of the metacarpophalangeal joints in rheumatoid arthritis. Proc R Soc Med. 1973;66(2):197–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  56. Swanson AB. Finger joint replacement by silicone rubber implants and the concept of implant fixation by encapsulation. Ann Rheum Dis. 1969;28 Suppl 5:47–55.

    PubMed Central  PubMed  Google Scholar 

  57. Parker WL, Rizzo M, Moran SL, Hormel KB, Beckenbaugh RD. Preliminary results of nonconstrained pyrolytic carbon arthroplasty for metacarpophalangeal joint arthritis. J Hand Surg Am. 2007;32(10):1496–505.

    Article  PubMed  Google Scholar 

  58. McCain JP, Sanders B, Koslin MG, Quinn JH, Peters PB, Indresano AT. Temporomandibular joint arthroscopy: a 6-year multicenter retrospective study of 4,831 joints. J Oral Maxillofac Surg. 1992;50(9):926–30.

    Article  CAS  PubMed  Google Scholar 

  59. Berner S. Metacarpophalangeal arthroscopy: indications and technique. Tech Hand Up Extrem Surg. 2008;12(4):208–15.

    Article  PubMed  Google Scholar 

  60. Cobb T, Berner S, Badia A. New frontiers in hand arthroscopy. Hand Clin. 2011;27(3):383–94.

    Article  PubMed  Google Scholar 

  61. Thomsen N, Nielsen N, Jorgensen N, Bojsen-Moller F. Arthroscopy of the proximal interphalangeal joints of the finger. J Hand Surg Br. 2002;27(3):253–5.

    Article  CAS  PubMed  Google Scholar 

  62. Sekiya I, Kobayashi M, Okamoto H, Iguchi H, Waguri-Nagaya Y, Goto H, Nozaki M, Tsuchiya A, Otsuka T. Arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints. Tech Hand Up Extrem Surg. 2008;12(4):221–5.

    Article  PubMed  Google Scholar 

  63. Ho P-C. Arthroscopic partial wrist fusions. Tech Hand Up Extrem Surg. 2008;12(4):242–65.

    Article  PubMed  Google Scholar 

  64. DelPinal F, Luchetti R, Mathoulin C, editors. Arthroscopic management of distal radius fractures. Heidelberg, Germany: Springer Verlag; 2010.

    Google Scholar 

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Authors and Affiliations

  1. Badia Hand to Shoulder Center, OrthoNOW Orthopedic Urgent Care Centers, 3650 NW 82nd Avenue, Suite 103, Doral, FL, 33166, USA

    Alejandro Badia M.D.

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  1. Alejandro Badia M.D.
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Correspondence to Alejandro Badia M.D. .

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  1. Department of Orthopedic Surgery, University of Mississippi, Jackson, Mississippi, USA

    William B. Geissler

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Badia, A. (2015). Small Joint Arthroscopy. In: Geissler, W. (eds) Wrist and Elbow Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1596-1_27

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  • DOI: https://doi.org/10.1007/978-1-4614-1596-1_27

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