Wrist arthroscopy allows direct visualization of the cartilage surfaces, synovial tissues, and ligaments under bright light and magnification. Wrist arthroscopy, particularly, is a valuable adjunct in the management of disorders of the triangular fibrocartilage complex (TFCC).
Acute injury to the TFCC includes tears of the fibrocartilage articular disk substance and meniscal homolog as well as radio-ulnar ligament avulsions, with or without an associated fracture. Patient evaluation includes clinical examination, imaging studies, and wrist arthroscopy (diagnostic). The Palmer classification is typically used to define injuries to the triangular fibrocartilage complex. The critical distinction is in differentiating injuries that produce instability of the distal radio-ulnar joint from those that do not.
Nonsurgical management includes temporary splint immobilization of the wrist and forearm, oral NSAIDs, corticosteroid joint injection, and physical therapy.
Surgery is indicated in patients who fail conservative treatment or in those who have a frank symptomatic instability of the DRUJ.
