Our Summary

Wrist arthroscopy, a minimally invasive surgical procedure performed on the wrist, is widely used to diagnose a type of injury known as a triangular fibrocartilage complex (TFCC) tear. However, it’s uncertain how accurately this procedure can identify TFCC tears. In this study, five hand surgeons analyzed 43 wrist arthroscopy videos to assess the accuracy of this diagnostic tool. They did this twice, with a 4-6 week gap between the two reviews.

The results showed that the surgeons were fairly consistent in their ability to identify TFCC tears, but their agreement on the specific type and location of the tear was low. This was especially the case for non-central TFCC tears, where their agreement was poor.

This suggests that although experienced surgeons can generally identify a TFCC tear during a wrist arthroscopy, they often disagree on its specifics, especially for non-central tears. This could impact treatment decisions for patients with TFCC tears. The study concludes that there is a need for better education on wrist arthroscopy anatomy to improve the accuracy of these diagnoses.

FAQs

  1. What is wrist arthroscopy and what is it used to diagnose?
  2. How accurate is wrist arthroscopy in diagnosing triangular fibrocartilage complex (TFCC) tears?
  3. Why is there a need for better education on wrist arthroscopy anatomy?

Doctor’s Tip

A helpful tip a doctor might give a patient about wrist arthroscopy is to be aware that while the procedure is effective in identifying TFCC tears, there may be some variability in the specific details of the tear that are identified by different surgeons. It’s important to discuss the results of the arthroscopy with your healthcare provider and seek a second opinion if needed to ensure the most accurate diagnosis and treatment plan. Additionally, staying informed and educated about the anatomy of the wrist can help improve the accuracy of the diagnosis and treatment decisions.

Suitable For

Patients who are typically recommended for wrist arthroscopy include those with persistent wrist pain, swelling, clicking or popping in the wrist joint, limited range of motion, and a history of traumatic injury to the wrist. Patients with suspected TFCC tears, ligament injuries, cartilage damage, or chronic wrist conditions that have not responded to conservative treatments may also be recommended for wrist arthroscopy. Ultimately, the decision to recommend wrist arthroscopy will depend on the individual patient’s symptoms, medical history, and diagnostic imaging results.

Timeline

Before wrist arthroscopy:

  1. Patient experiences wrist pain, swelling, and limited range of motion.
  2. Patient undergoes physical examination and imaging tests such as X-rays or MRI to determine the cause of the symptoms.
  3. If a TFCC tear is suspected, the patient may be recommended for wrist arthroscopy for a more accurate diagnosis.

After wrist arthroscopy:

  1. Patient undergoes the minimally invasive surgical procedure under anesthesia.
  2. Surgeons insert a small camera (arthroscope) into the wrist joint to visualize and assess any damage to the TFCC.
  3. Surgeons may perform repairs or other procedures to address the TFCC tear during the arthroscopy.
  4. Patient may experience soreness, swelling, and stiffness in the wrist following the procedure.
  5. Patient undergoes post-operative rehabilitation and physical therapy to regain strength and mobility in the wrist.
  6. Patient follows up with the surgeon for monitoring and evaluation of the surgical outcomes.

What to Ask Your Doctor

  1. What is wrist arthroscopy and how does it help diagnose wrist injuries like TFCC tears?
  2. How experienced are you in performing wrist arthroscopy procedures?
  3. What are the potential risks and complications associated with wrist arthroscopy?
  4. How accurate is wrist arthroscopy in identifying TFCC tears, especially non-central tears?
  5. What alternative diagnostic tests or procedures are available to confirm a TFCC tear diagnosis?
  6. How will the results of the wrist arthroscopy procedure impact my treatment plan?
  7. Can you explain the specifics of my TFCC tear, such as the type and location, based on the wrist arthroscopy findings?
  8. How will you ensure that the treatment plan is tailored to my specific TFCC tear diagnosis?
  9. Are there any additional tests or imaging studies that may be helpful in confirming or further evaluating my TFCC tear?
  10. What is the expected recovery timeline and outcome following wrist arthroscopy for a TFCC tear?

Reference

Authors: Graesser EA, Wall LB, Kakar S, Yao J, Richard MJ, Gaston RG, Goldfarb CA. Journal: J Hand Surg Am. 2025 Jan;50(1):2-9. doi: 10.1016/j.jhsa.2024.07.002. Epub 2024 Aug 9. PMID: 39115487