Wrist injuries: open surgery vs. arthroscopy

Mr Andrew Logan is a consultant orthopaedic surgeon who specialises in hand and wrist surgery. We were fortunate to ask him all about the different types of wrist conditions, including how common they are, the possible causes and whether open surgery has a better long-term outcome than wrist arthroscopy. 

How common are wrist disorders?

As a specialist hand surgeon, I am referred cases that involve the wrist and hand. In relative terms, wrist conditions represent a small proportion compared to those that affect the hand. I would estimate that around 10-20% of patients that I see have a wrist problem.
 

How do you categorise wrist disorders?

There are a large number of conditions that affect the wrist. There are two broad categories, injury and non-injury-related conditions. Wrist injuries include fractures of the bones or injury to the ligaments that hold the bones together. 

Non-injury related conditions include wrist ganglia (fluid-filled swelling over the wrist), arthritis (wear and tear or inflammation arthritis) and inflammation of the tendons. There is some overlap between injury and non-injury as under-diagnosed or untreated fractures or ligament injuries can cause arthritis in the longer term.
 

Which wrist conditions may require surgery?

Wrist injuries may or may not require surgery depending on the severity of the injury to the bone, ligaments or soft tissue.

Most non-injury related wrist conditions can be treated with simple pain-relieving medication, splinting, therapy or activity modification. It is always important to remember that an operation is not without risk.
 

What happens during wrist surgery?

The majority of wrist surgery would be classed as open surgery. This is where a cut is made in the skin in order to visualise the anatomy to successfully complete the operation. Most operations for wrist arthritis are performed using open surgery.
 

What is wrist arthroscopy?

In some conditions, it is possible to perform keyhole surgery in the form of wrist arthroscopy. This is where between two and four small cuts are made in the back of the wrist and the operation is performed using a camera inside the wrist and small instruments. There is often less scarring and quicker recovery with wrist arthroscopy. However, the indications for using wrist arthroscopy are limited.

Wrist arthroscopy is most useful in tidying up inflammation in the wrist that has not responded to a steroid injection. It can be used as a method to treat some types of ligament injury. Some hand units will use wrist arthroscopy to treat more complex wrist conditions.

Wrist arthroscopy is far superior for some conditions compared to an open procedure. However, the surgeon has to be aware that although other conditions can be treated by arthroscopy, an open procedure can represent less risk and give a better long-term outcome.
 

What can be expected after wrist surgery?

Outcomes of wrist surgery are very variable. The outcome depends on the condition and the operation performed. Some operations are much more reliable than others. It is therefore important that the patient has a detailed discussion with the treating surgeon with regard to risks, outcome and recovery before deciding to operate.

Book an appointment with Mr Logan now via his Top Doctor's profile here if you would like his expert opinion on your hand or wrist pain.