Wrist Arthroscopy Is Effective for the Diagnosis and Treatment of Chronic Wrist Pain in Pediatric Patients

Overview

Journal Arthrosc Sports Med Rehabil

Date 2022 Aug 29

PMID 36033170

Authors

Raphael Fischer

Samuel B Tschudi

Dirk J Schaefer

Alexandre Kaempfen

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the outcomes of diagnostic and therapeutic arthroscopy in patients with chronic wrist pain who are younger than 16 years of age.

Methods: We retrospectively analyzed collected data from medical records of patients who had undergone wrist arthroscopy by the senior author between 2015 and 2017 for longstanding wrist pain and were 16 years old or younger. Findings from preoperative magnetic resonance imaging (MRI) were compared with the intraoperative diagnosis, and midterm results were gathered by a telephone interview.

Results: Ten patients were included. Eight of 10 patients had undergone conservative therapy before surgery, and 60% had a history of single trauma. In 6 of 10 patients, the arthroscopic diagnosis correlated with the MRI findings. Eight of 10 wrists (80%) showed a tear of the triangular fibrocartilage complex (TFCC). Only 4 of the 8 TFCC tears were correctly identified by 3-Tesla MRI.

Conclusions: In our study, wrist arthroscopy was an effective tool not only to diagnose but also to treat relevant TFCC lesions both in adolescents and children suffering from persistent wrist pain. A 3-Tesla MRI was neither sensitive nor specific enough to correctly diagnose lesions in small pediatric wrists.

Level Of Evidence: IV, Therapeutic case series.

References

Shionova K, Nakamura R, Imaeda T, Makino N . Arthrography is superior to magnetic resonance imaging for diagnosing injuries of the triangular fibrocartilage. J Hand Surg Br. 1998; 23(3):402-5. DOI: 10.1016/s0266-7681(98)80068-5. View

Liao J, Chong A, Meng Kiat Tan D . Causes and assessment of subacute and chronic wrist pain. Singapore Med J. 2013; 54(10):592-7. DOI: 10.11622/smedj.2013205. View

Mikic Z . Age changes in the triangular fibrocartilage of the wrist joint. J Anat. 1978; 126(Pt 2):367-84. PMC: 1235694. View

Atzei A, Luchetti R . Foveal TFCC tear classification and treatment. Hand Clin. 2011; 27(3):263-72. DOI: 10.1016/j.hcl.2011.05.014. View

Ochman S, Wieskotter B, Langer M, Vieth V, Raschke M, Stehling C . High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary?. Arch Orthop Trauma Surg. 2017; 137(10):1443-1450. DOI: 10.1007/s00402-017-2747-2. View

Anderson M, Skinner J, Felmlee J, Berger R, Amrami K . Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. J Hand Surg Am. 2008; 33(7):1153-9. DOI: 10.1016/j.jhsa.2008.02.028. View

Atzei A, Rizzo A, Luchetti R, Fairplay T . Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg. 2008; 12(4):226-35. DOI: 10.1097/BTH.0b013e3181901b1. View

Legault E, Descarreaux M, Cantin V . Musculoskeletal symptoms in an adolescent athlete population: a comparative study. BMC Musculoskelet Disord. 2015; 16:210. PMC: 4543469. DOI: 10.1186/s12891-015-0681-4. View

Leclercq C, Mathoulin C . Complications of Wrist Arthroscopy: A Multicenter Study Based on 10,107 Arthroscopies. J Wrist Surg. 2016; 5(4):320-326. PMC: 5074840. DOI: 10.1055/s-0036-1584163. View

10.

Joshy S, Ghosh S, Lee K, Deshmukh S . Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop. 2007; 32(2):251-3. PMC: 2269009. DOI: 10.1007/s00264-006-0311-8. View

11.

Ramavath A, Unnikrishnan P, George H, Sathyamoorthy P, Bruce C . Wrist Arthroscopy in Children and Adolescent With Chronic Wrist Pain: Arthroscopic Findings Compared With MRI. J Pediatr Orthop. 2017; 37(5):e321-e325. DOI: 10.1097/BPO.0000000000000887. View

12.

Chloros G, Wiesler E, Poehling G . Current concepts in wrist arthroscopy. Arthroscopy. 2008; 24(3):343-54. DOI: 10.1016/j.arthro.2007.10.006. View

13.

Wu M, Miller P, Waters P, Bae D . Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents. J Hand Surg Am. 2019; 45(5):449.e1-449.e9. DOI: 10.1016/j.jhsa.2019.06.019. View

14.

Ritt M . Arthroscopy: the giant leap forward in wrist surgery?. J Hand Surg Br. 2001; 26(3):238-40. DOI: 10.1054/jhsb.2001.0617. View

15.

Terry C, Waters P . Triangular fibrocartilage injuries in pediatric and adolescent patients. J Hand Surg Am. 1998; 23(4):626-34. DOI: 10.1016/S0363-5023(98)80048-8. View

16.

Scheck R, Romagnolo A, Hierner R, Pfluger T, Wilhelm K, Hahn K . The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy. J Magn Reson Imaging. 1999; 9(3):468-74. DOI: 10.1002/(sici)1522-2586(199903)9:3<468::aid-jmri16>3.0.co;2-t. View

17.

Farr S, Grill F, Ganger R, Graf A, Girsch W . Pathomorphologic findings of wrist arthroscopy in children and adolescents with chronic wrist pain. Arthroscopy. 2012; 28(11):1634-43. DOI: 10.1016/j.arthro.2012.04.152. View

18.

Palmer A . Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989; 14(4):594-606. DOI: 10.1016/0363-5023(89)90174-3. View

19.

Trehan S, Schimizzi G, Shen T, Wall L, Goldfarb C . Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients. J Hand Surg Eur Vol. 2019; 44(6):582-586. DOI: 10.1177/1753193418825070. View

20.

Braun H, Kenn W, Schneider S, Graf M, Sandstede J, Hahn D . [Direct MR arthrography of the wrist- value in detecting complete and partial defects of intrinsic ligaments and the TFCC in comparison with arthroscopy]. Rofo. 2003; 175(11):1515-24. DOI: 10.1055/s-2003-43404. View