Arthroscopic arthrolysis procedure effective for post-fracture wrist rigidity and pain

Although some patients did not achieve complete wrist range of motion, all were satisfied with their results.

Arthroscopic arthrolysis can be safely used to treat wrist rigidity and stiffness resulting from previous surgery or trauma, a study by surgeons in Italy shows.

Riccardo Luchetti, MD, and colleagues reviewed their experience performing the procedure in 22 patients treated from 1988 to 2003 at an average age of 37 years. They published their results in the journal Arthroscopy.

Researchers selected cases included in the study according to strict criteria. The primary indication for surgery was the patient's level of wrist rigidity and whether it was associated either with or without pain, "considering that wrist rigidity alone was not important enough to require arthroscopic arthrolysis, but when associated with pain, this surgical technique is strongly indicated," the authors wrote.

Other indications for surgery included decreased grip strength and poor results after up to 6 months of rehabilitation, according to the study.

Surgeons initially removed fibrotic adhesions arthroscopically through radiocarpal, midcarpal and distal radioulnar portals based on the site of wrist rigidity. They also resected the volar or distal radiocarpal ligaments when necessary to improve wrist range of motion.

Surgeons additionally addressed other joint pathologies intraoperatively when indicated, such as ulnar-carpal impingement, triangular fibrocartilage complex (TFCC) tears and chondritis, according to the study.

Patients immediately began rehabilitation postoperatively. This involved roughly 3 months of pronation-supination and flexion-extension exercises with gradually increasing resistance.

In all cases, arthroscopy revealed the presence of fibrotic bands between the radius and carpal bones. Three cases also had fibrotic bands in the ulnocarpal joint, the authors reported.

Other pathologies identified during surgery included nine cases with loose bodies, five cases with scapholunate ligament partial tears and four cases with TFCC tears.

No patients experienced any complications, the authors noted.

At 28 months mean follow-up, pain had significantly reduced for all patients and averaged 2.09 points on the Visual Analog Scale compared to 7.73 points preoperatively.

The modified Mayo wrist score also significantly improved, from 28 points preoperatively to 79 points. The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 21 points at final follow-up.

Additionally, wrist range of motion and grip strength both significantly improved after surgery, the authors reported.

"Although not all patients obtained complete wrist [range of motion], they all confirmed that they were satisfied with the obtained results, as shown by the Mayo wrist score and DASH questionnaire results," they wrote.

For more information:
Luchetti R, Atzei A, Fairplay T. Arthroscopic wrist arthrolysis after wrist fracture. Arthroscopy. 2007;23:255-260.