Arthroscopic Procedures
An arthroscopic procedure is a procedure performed on a joint that involves the introduction of a camera and various instruments into the joint via small cannulae (metal or plastic tube). The advantage of this is direct visualisation of the inside of the joint, as well as the ability to perform surgery on the structures within in the joint. Surgical scars are also smaller and recovery time is reduced.
Arthroscopic procedures are commonly performed on the shoulder and knee. They can also be performed on the elbow and wrist.
Commonly performed procedures
Carpal Tunnel Release
Carpal and Cubital Tunnel Release
Patients that experience numbness and muscle wasting from nerve compression at the wrist (Carpal Tunnel Syndrome) or the elbow (Cubital Tunnel Syndrome) will benefit from a nerve release.
An incision about 3cm long is made over the affected area and the tight band of fibrous tissue compressing the nerve is excised. Any scar tissue surrounding the nerve is removed. If the compression around the elbow is severe the nerve may need to be moved forward.
Post-operatively the wrist is splinted (Carpal Tunnel Syndrome) or the elbow is placed in a sling (Cubital Tunnel Syndrome) for a period of 10-14 days to allow healing to occur. After this, the splint/sling is removed and exercises are started. Lifting heavy objects should be avoided for the first 6 weeks. Driving can be started within 1-2 days after surgery. Exercising / Gym can usually commence within 1 week.
Joint Replacement Thumb
In end stage arthritis of the base of the thumb and Trapeziectomy and Tightrope of the thumb may need to be performed.
The trapezium (small bone at base of thumb) is excised and the thumb is suspended with a tightrope. The hand is placed in a cast for 6 weeks to allow healing to occur. After this period, hand strengthening with an occupational therapist needs to be started. This procedure treats the pain and difficulty grasping objects caused by the arthritis extremely well.
Driving can be started within 1-2 days. If you are doing exercises that can be continued with the cast e.g. walking or running, then you may start exercising within 1 week of the surgery.
Trigger Finger/Thumb Release
An initial trial of conservative management is usually attempted to treat trigger finger/thumb. This consists of a cortisone injection into the A1 pulley located near the knuckle joint. Daily massage and strengthening is also performed. This usually succeeds in 70-80% of cases.
In those patients that fail conservative management or where the triggering is to far advanced a surgical release is performed. A small incision is made over the A1 pulley and the pulley is incised. The inflammation is debrided from the flexor tendons and they are inspected to ensure adequate tendon gliding. The skin is sutured and the hand placed in a bulky dressing.
ROM is encouraged from day 1 and normal activities can usually resume by two weeks. Heavy lifting / gym is reduced for the first 6 weeks.
Ganglion Excision
A ganglion is a small fluid filled cyst arising from the joint. These usually require surgical excision to adequately treat and prevent recurrence. The cyst is excised and any small bone spurs removed from the joint at the same time. The hand is placed in a splint to allow the incision to heal for two weeks and then ROM and strengthening started.