[Results of arthroscopic synovialectomy of the wrist].
In the course of inflammatory rheumatic diseases, isolated synovialitis of the wrist and distal radioulnar joint can be found without simultaneous affection of the extensor tendons. It may be the only manifestation of the disease in the sense of monarthritis or one of few affected sites as in oligoarthritis. With modern medical treatment of disease-modifying drugs, this constellation seems to be more frequent. In this situation, we rather perform arthroscopic synovialectomy than open synovialectomy as long as form and function of the joint are maintained. The distal radioulnar joint may also be approached arthroscopically through the perforation of the TFCC, which is usually encountered. A clinical study was performed to evaluate the results of this procedure concerning function, relief of pain, progression of the disease, and risk of recurrence. Between 1995 and 2000, 22 patients (15 female, 7 male) with an average age of 50 years (range 16 to 74) were operated, in one case both wrists. 19 patients have been reexamined clinically and by X-ray after an average follow-up of 21 months (range 6 to 57 months), three by telephone interview. The results were evaluated according to the Mayo modified wrist score (pain, function, motion, and grip-strength related to the contralateral side) and compared to the preoperative values. In the case of bilateral affection, the score was not applied. Also, the patients' subjective evaluation of the results have been taken into account. Progression of the disease has been checked in the standard preoperative and postoperative X-rays of the wrist graded according to the Larsen scale. Special attention was paid to signs of recurrence. The wrist-score improved significantly from an average of 40 points preoperatively to 69 points postoperatively. Eleven patients estimated their wrists as absolutely good, nine as improved, two as unchanged compared to the preoperative situation. Nine patients reported no pain at all, eleven less pain than before and two no change. 17 patients have been satisfied with the procedure, five not. Radiographic progression of the disease from the preoperative status (Larsen stage 0 to III, exceptionally IV) to postoperative was found in three cases. In 19 cases there was no progression. Recurrence was noted in six cases after an average time of six months; a secondary procedure was necessary in two cases. Wrist motion improved in almost all patients from an average value of extension plus flexion of 83 degrees preoperatively to 99 degrees postoperatively. Conclusion. Arthroscopic synovialectomy of the wrist reduces pain and improves function in most cases. It also improves motion, which is an advantage to the open procedure. Patient acceptance of the procedure is high.
Abteilung für Handchirurgie, Plastische und Rekonstruktive Chirurgie der DRK-Klinik Baden-Baden, Germany. HeinrichTuennerhoff@swol.de
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D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000601:surgery*; D001182:Arthroscopy; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012086:Reoperation; D000074402:Synovectomy; D013583:Synovial Membrane / Q000473:pathology; D013585:Synovitis / Q000175:diagnosis / Q000601:surgery*; D014955:Wrist Joint / Q000473:pathology / Q000601:surgery*