All-Inside Arthroscopic Techniques May Improve Treatment of Wrist PainTriangular fibrocartilage complex is a disorder of the wrist. The cartilage, tough fibrous connective tissue, is damaged or torn. The most common sign of triangular fibrocartilage complex is pain on the ulnar side of the wrist, the outside of the arm, closest to the "little" finger.
There are two classifications of triangular fibrocartilage complex called the Palmer classifications, each of which has several sub-classifications, depending on the extent of the damage: Class 1 means that the injury happened as the result a trauma and class 2 is the result of degeneration. Class 2 injuries are more common than class 1. It was also thought that Class 1 injuries were more difficult to treat than were class 2 injuries.
Researchers were interested in learning about the cells were made up, how deterioration happened around the injured area and how this affected healing. There was a common thought that patients who had Palmer class 1A injuries, where the cartilage is perforated, or a hole has been made, in the middle, could not have their lesion repaired. However, the researchers found that they can heal. In one study, patients with class 1A injuries had arthroscopic surgery, done with tiny incisions and long instruments with a camera on one end. The arthroscopic surgery allowed the doctor to see the injury and shorten the bone, repairing the damage. When the patients were examined by arthroscopy later, half of the tears or perforations were healing. In a different study, surgeons removed tissue around the tears from people with class 1A injuries and examined them for degeneration of the tissue cells. They found that even 18 months after the injury, there was degeneration in the cells and that they were beginning to look like a classification of degeneration, the Palmer 2C class, where the injury had perforated but due to degeneration instead of trauma.
The authors of this article wrote that the recent advancements of high-resolution, more detailed MRIs (magnetic resonance imaging) and arthrography (joint x-rays) have allowed doctors to study these injuries in much more detail. When these tests became available, researchers began comparing their findings with the tests against those from arthroscopic examination. They found that while the tests were accurate for some types of injuries, they weren't for others.
As researchers worked at trying to find better ways to perform the surgery on the wrist, they noticed that the triangular fibrocartilage complex was very much like injuries in the knee. So, by using the techniques used in arthroscopic knee surgery, the researchers were able to develop more precise and effective techniques for the wrist. By using an all-inside arthroscopic technique, the surgeons were able to see what the problem was, diagnose it and treat it.
Arthur T. Lee and Jeffrey Yao. An update on the triangular fibrocartilage complex. In Current Orthopaedic Practice. September/October 2008. Vol. 19. no. 5. Pp. 509-514.
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