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Improved results seen with arthroscopic debridement for dorsal wrist syndrome
Arthroscopic debridement of the patulous wrist capsule was associated with less wrist pain, and more extension and function.
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Arthroscopic debridement is a viable treatment for patients with dorsal wrist syndrome, according to a researcher who presented results with the technique.
“Dorsal wrist syndrome can be successfully managed with arthroscopic debridement,” Ramesh Srinivasan, MD, said in a presentation at the Arthroscopy Association of North America Annual Meeting.
In their abstract, Srinivasan and colleagues defined dorsal wrist syndrome (DWS) as a dorsal wrist ligament avulsion that causes the patulous wrist capsule to extend into the radiocarpal joint, but Srinivasan noted in his presentation there is a lack of peer-reviewed clinical evidence for arthroscopy as a treatment for DWS.
Therefore, he and colleagues conducted a retrospective chart review of 14 patients (seven men and seven women) with an average age of 29 years who underwent arthroscopic debridement for DWS between 2007 and 2012.
Srinivasan and colleagues included patients with pain with passive wrist extension and stage 1 injury documented by MRI and excluded patients with radiocarpal arthritis or carpal malalignment.
The mechanism of injury or cause of pain for these patients was pain with wrist extension (seven patients), a fall on an outstretched arm (four patients) and a twisting injury (one patient); the mechanism of injury was unknown for two patients.
Arthroscopic exploration
“All patients exhausted conservative treatment prior to surgery, including splinting and injections,” Srinivasan said.
The average time from onset of symptoms to surgery was 10 months.
During the arthroscopy procedures, the investigators found that all patients had a patulous dorsal wrist capsule that protruded into the radiocarpal joint and partial detachment of the dorsal radiocarpal and dorsal intercarpal ligaments. Surgeons arthroscopically debrided the patulous wrist capsule and membranous fraying of the scapholunate interosseous ligament.
Following debridement, investigators noted that average wrist extension of 61° preoperatively improved to 78°. The preoperative mean VAS pain score improved from 4.1 points to 1.2 points postoperatively and the preoperative Quick DASH mean score of 33 points improved to 11 points, according to Srinivasan.
Complications, limitations
One patient developed a complication — cellulitis — which was treated with antibiotics, Srinivasan said.
The retrospective nature of the study and the lack of long-term radiographic follow-up limited the research because the long-term progression of the syndrome and any associated arthrosis “remain unknown,” he said.
“Patients who had the treatment demonstrated improved wrist pain, wrist extension and function postoperatively,” Srinivasan said. “Both the scapholunate interosseous ligament and any impinging dorsal wrist capsules can be treated at the time of surgery.” – by Renee Blisard Buddle
- Reference:
- Srinivasan R. Paper #SS-51. Presented at: Arthroscopy Association of North America Annual Meeting; April 25-27, 2013; San Antonio, USA.
- For more information:
- Ramesh Srinivasan, MD, can be reached at The Hand Center of San Antonio, 21 Spurs Ln. #310, San Antonio, TX 78240, USA; email: rameshcsrinivasan@gmail.com.
Disclosure: Srinivasan has no relevant financial disclosures.
Perspective
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Philippe A. Liverneaux, MD PhD
The dorsal wrist syndrome (DWS) is a little-known syndrome which is probably the first phase of scapholunate ligament (SLIO) injuries and dorsal capsule injuries, especially those of the dorsal intercarpal ligament (DIC). The work of the European Wrist Arthroscopy Society (EWAS) has recently emphasized the great importance of the dorsal capsule in the scapholunate instability resulting from a tear of the DIC and SLIO.
We regret that the authors of this study did not mention whether their patients had a wrist trauma before the appearance of DWS. This information could support the theory of DWS belonging to more serious scapholunate injuries, which would be type 0 of the EWAS classification.
In this series, treatment of DWS has given good results simply by debridement. It makes sense to get good short-term results after debridement. We regret the authors did not state the mean follow-up. One might think that the results will continue over time because the capsular healing after debridement often has the effect of strengthening the mechanical properties of the soft tissues.
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