gms | German Medical Science

Objectives: Wrist pain is relatively rare within childhood and adolescence. Although many possess a traumatic background, clinicians should bear in mind that there might be underlying inflammatory diseases or congenital malformations.

Wrist arthroscopy is a valuable step for management of wrist disorders which has grown from a diagnostic tool to a curative, adjunctive procedure. Our aim is to report preliminary results of diagnostic and therapeutic wrist arthroscopy(WASC) in youngsters with persistent wrist pain.

Method: Retrospective review of 24 children and adolescents who underwent WASC between 2014–2017 was done.18 girls and 6 boys with mean age of 14.6 (11-18) were operated.

Indication was chronic wrist pain refractory to nonsurgical treatment for more than 12 weeks following trauma, systemic inflammatory disease, selected cases of congenital and developmental disorder.

Results: Ten of 24 patients had a history of ipsilateral upper limb trauma. 6/24 were suspected of TFCC tears in MRI reports. 4/24 had rheumatoid symptoms, Juvenile idiopathic arthritis(JIA), arthrogryposis. Rest had persistent, unclassified wrist pain and needed diagnostic WASC.

Procedure was a daycase operation; done under sedation and regional block; undertaken by 2 hand surgeons.

14 patients were demonstrated to have synovitis at ulnocarpal, radiocarpal, midcarpal joint capsules; treated with WASC synovectomy. 5 TFCC Palmer 1A tears and 7 midcarpal hypermobilities without clinical instability were managed by TFCC debridement, midcarpal joint capsule shrinkage.

3 patients received WASC ganglionectomies for dorsal wrist ganglions.

One case showed partial split at radioscaphocapitate ligament; demonstrating extra strand of scar.

Other pathologies were scapholunat, lunotriquetral ligament hypermobility, TFCC dimpling, sagging, ulnar abutment, triquetral chondromalacia. No complications were observed.

Conclusion: Wrist arthroscopy is a safe procedure to detect and treat paediatric wrist disorders. We treated 24 children with arthroscopic capsule shrinkage for midcarpal hypermobilities, TFCC debridements and synovectomies.

In addition, a subgroup of JIAs had few clinical symptoms despite known progressive and extensive joint destruction where arthroscopic synovectomy was performed.

We believe that early identification of these "silent destructors" and subsequent intervention could possibly delay joint destruction and preserve function.

In conclusion, we certainly believe that this procedure, should only be carried out by well-trained, experienced hand surgeons.