Small Joints

Arthroscopic interventions on small joints, such as wrist, elbow and finger joints, play an important role in diagnosis and therapy.

Wrist joint

The wrist joint is a very complex joint in the human body and it is, in fact, made up of a number of individual joints.
Assessments of the cartilage status, ligament instabilities and changes to the mucus membrane can be diagnosed and biopsies can be taken. For example, lesions to the attachment of the hand joint at the ulna (triangular fibrocartilage disk) can be treated arthroscopically. A distinction is drawn in arthroscopic interventions between resecting and reconstructing procedures. Synovectomies, arthrolyses, cartilage smoothing interventions and debridement procedures are some of the resecting procedures. Refixation of the ulnar diskoid cartilage and its ligament connections to the ulna (TFCC repair) are included among the reconstruction methods.

Richard Wolf supplies the ideal solution for all small joints. The range of options includes telescopes with diameters of 1.9 mm, 2.4 mm or 2.7 mm and a comprehensive instrument portfolio specially matched to these applications.

Elbow

Arthroscopy of the elbow is a relatively new procedure. Faster rehabilitation, lower levels of wound pain, reduced risk of infection and less surgical trauma are the benefits. However, the precise assessment of underlying pathologies, in particular instabilities, has derived significant benefit through the diagnostic possibilities offered by elbow arthroscopy.
Elbow arthroscopy allows the severity and direction of new and chronic instabilities to be assessed and any necessary treatment strategy to be derived from the findings. This includes the treatment indications for fresh capsule-ligament suture or syndesmoplasty (ligament reconstruction) in cases of chronic instability.

The therapeutic options offered by elbow arthroscopy cover the spectrum of arthrolysis in primary and secondary arthroses. If the therapeutic indication is correct, better functional outcomes can be obtained involving lower morbidity compared with open arthrolysis. If these instruments are used in the hands of trained and experienced, surgeons, the level of complications is low despite the close proximity of vascular and neural pathways, provided that a standardized technique is used and the relevant landmarks are respected. A complex arthrolysis can involve the removal of arthroliths floating in the joint, ablation of osteophytes, intraarticular debridement of soft tissue with synovectomy, cartilage smoothing, release of the triceps muscle and complete ventral capsulotomy.
If patients are suffering from rheumatism, arthroscopic synovectomy of the elbow has a defined status within the treatment concept alongside basic drug therapy directed toward reducing aggressive development patterns.

Other indications for elbow arthroscopy are osteochondrosis dissecans with the necessary cartilage therapy required depending on the stage reached.
They include arthroscopic procedures for direct and indirect drilling, as well as microfracturing and chondroplasty with debridement. In special cases, the fracture can also be treated with arthroscopic assistance. A more precise assessment can be provided for the cartilage damage and articular displacement. This in turn achieves better results for reinstating injured joints and permits improved assessment for the extent of the injury.
Another important indication for elbow arthroscopy lies in identifying the treatment concept for radial epicondylitis. Several studies have indicated a causal link between posterolateral rotation instability as a cause for chronic radial epicondylytis. Furthermore, intraarticular pathologies, such as major inflammatory plica synovialis, cartilage injury, and floating arthroliths, have been identified as causes for chronic radial epicondylitis resistant to therapy. Intraarticular diseases causing radial epicondylitis can often only be identified and treated arthroscopically.
If there are significant posterolateral rotation instabilities, syndesmoplasty of the LUCL complex (Lateral Ulnar Collateral Ligament) would also be indicated in addition to open intervention, which involves debridement with denervation and reinsertion of the extensors. Syndesomoplasty with a triceps tendon transplant has proved effective.

The new Elbow Set has been designed by Richard Wolf to provide adequate support. A practical combination of instruments and specific, highly functional design form the platform for safe and successful intervention.
The arthroscopist benefits from the perfect integration of all components to the anatomical requirements and optimum harmonization with all the pathologies being treated. These features also facilitate the reduction of risks caused by delays and any resulting critical swellings.